IV. EFFECTS OF THE LAW CHANGE IN FLORIDA
The Law
Florida originally adopted an all-rider motorcycle helmet law in 1967. It was this law that was amended effective July 1, 2000, to require helmet use only by riders under the age of 21. Riders 21 and older who do not wear helmets must have at least $10,000 in medical insurance coverage.
Helmet Use
Observational Surveys
A Florida helmet use observation survey carried out before the helmet law change (Center for Urban Transportation Research, 1998) showed that virtually all observed riders were wearing helmets. However, only 59 percent of the observed sample wore compliant helmets (headgear that meets FMVSS No. 218), while 40 percent were wearing noncompliant helmets (headgear that does not meet FMVSS No.218). These figures compare to 84 percent compliant and 15 percent noncompliant observed in a 1993 survey, suggesting that noncompliant helmet use was increasing over time. Following weighting, the 1998 survey results yielded estimated statewide helmet use of 65 percent compliant helmets and 35 percent noncompliant helmets.
A post law change survey, done in 2002, (Turner and Hagelin, 2004) found 47 percent compliant helmet use, 6 percent noncompliant helmet use and 47 percent no helmet use. These results indicate that use of compliant helmets has declined following the law change while wearing noncompliant helmets has largely been abandoned.
Crash Involvement
Helmet use among motorcyclists involved in crashes before and after the law change is shown in Table 3. Among the 515 motorcyclists killed in traffic crashes in the three years prior to the helmet law change (1997-1999), 9.4 percent were recorded in FARS as not wearing a helmet. In the three years following the law change (2001-2003), 60.8 percent of the 933 fatally injured motorcyclists were reported being unhelmeted. In 1997-1999, there were 35 motorcyclists under the age of 21 killed in Florida. Of these, 25.7 percent were not helmeted. In 2001-2003, 101 motorcyclists under 21 were killed with 45.0 percent of them being unhelmeted.
Excluding cases where helmet use was not recorded
(less than 7 percent of the cases), 26.8 percent of all motorcyclists involved
in crashes in 1999, of all degrees of severity, were recorded in the Florida
crash database as being unhelmeted. In 2001, the figure was 51.4 percent. Among
motorcyclists who sustained incapacitating injury, 20.8 percent of those
involved in 1999 crashes were unhelmeted while 50.3 percent
of those involved in year 2001 crashes were not wearing helmets.
Among
riders under the age of 21, 39.8 percent of those involved in crashes in 1999
were unhelmeted. In 2001, the figure was 49.3 percent. For those sustaining
incapacitating injury, 35.4 percent of those in 1999 crashes were not helmeted
while in 2001, 49.5 percent were not helmeted.
Table 3. Helmet Use Among Florida Crash Involved Motorcyclists
|
1997-1999 |
2001-2003 | |
|---|---|---|
|
All Motorcyclists Killed (N) |
515 |
933 |
|
Percent Not Helmeted |
9.4% |
60.8% |
|
Motorcyclists < 21 Killed (N) |
35 |
101 |
|
Percent Not Helmeted |
25.7% |
45.0% |
|
1999 |
2001 | |
|
All Crash-Involved Motorcyclists (N) |
5,251 |
7,710 |
|
Percent Not Helmeted |
26.8% |
51.4% |
|
Incapacitating Injuries (N) |
1,428 |
1,890 |
|
Percent Not Helmeted |
20.8% |
50.3% |
|
<21 Age Involved (N) |
610 |
781 |
|
Percent Not Helmeted |
39.8% |
49.3% |
|
<Age 21 Incapacitating Injuries (N) |
145 |
199 |
|
Percent Not Helmeted |
35.4% |
49.5% |
Both the observational survey results and the fatal and other crash data show that helmet use has declined substantially in Florida since the repeal of the all-rider use law. The crash data also indicate that the declining use has extended to riders under the age of 21, the group that was to continue helmet use under the revised law.
Motorcycle Registrations
Table 4 and Figure 7 contain annual motorcycle registration data for the years 1994-2002. These data indicate that Florida registrations had been increasing gradually during the 1990s, then increased markedly coincidental with the repeal of the State's all-rider helmet law. This outcome is similar to what occurred in Arkansas, Louisiana, and Texas following helmet law repeals in those States.
Table 4. Florida Motorcycle Registrations, 1994-2002
|
Year |
Motorcycles Registered |
|---|---|
|
1994 |
177,374 |
|
1995 |
184,526 |
|
1996 |
189,574 |
|
1997 |
194,903 |
|
1998 |
207,371 |
|
1999 |
220,923 |
|
2000 |
240,844 |
|
2001 |
289,760 |
|
2002 |
323,301 |
Source Florida Department of Highway Safety and Motor Vehicles (DHSMV)
Figure 7. Annual Florida Motorcycle Registrations
Fatalities Motorcyclists Killed Fatalities per 10,000 Registered
Motorcycles Fatality Rate Fatalities Fatality Rate 125 7.0 139 7.6 152 8.2 141 7.4 160 8.2 178 9.1 173 8.3 169 7.8 164 7.4 241 10.0 274 9.5 288 9.4 301 9.3 358 n/a Source: Fatalities FARS; Registrations DHSMV These data indicate that there has been a substantial
increase in motorcyclists killed in Florida following repeal of the State's
all-rider helmet law in 2000 (though the increase started in the first six
months of 2000 before the law was effective in July). The 575 fatalities in the
two years following the law change (2001-2002) were 71 percent greater than the
337 fatalities that occurred in 1998-1999, compared to an increase of 37 percent
for the nation as a whole (4,560 to 6,227). Fatalities in Florida per 10,000
registered motorcycles increased 21 percent compared to 13 percent nationally
for the two years before and after the law change (See Figure 9). Another way to
look at this is to compare the average of the 30 months before and after the law
change. There was an annual average of 181 motorcyclists killed in Florida in
1998, 1999, and the first six months of 2000, compared to an average of 280 in
the last six months of 2000, 2001, and 2002, a 59 percent increase.
Registrations increased an average 33.7 percent (219,486 to 293,393) in this
time period. The expected number of motorcycle fatalities as a result of the
increase in registrations was 242 (181 x 1.337=242). The actual number who died
in 2002 was 301, 59 more motorcycle fatalities than expected as a result of
increased registrations alone (a 24 percent increase). Motorcyclist fatalities in Florida have continued to
increase. In the three years after the law change (2001-2003), 933
motorcyclists were killed, 81 percent more than the 515 motorcyclists who were
killed in 1997-1999. The actual number who died in 2003 was 358. Time Series Analysis Autoregressive Integrated Moving Average (ARIMA) models were
used to examine the relationship between the change in Florida's motorcycle
helmet law and motorcyclist fatalities. The date of the law change was used as
an intervention point in the time series. Data on motorcyclist fatalities in
Georgia were employed as a comparison. Georgia was selected based on proximity
to Florida and the fact that it had an all-rider helmet law in effect for the
entire time period. Monthly fatalities in Florida and Georgia, before and after
the intervention point (July 2000), were modeled in the presence of the annual
number of motorcycle registrations in each State. This was done to control for
the extent to which changes in fatalities were associated with changes in
motorcycle registrations The numbers of monthly motorcyclist fatalities for Florida and
Georgia from 1994 to 2002 were included in the analysis. The number of annual
motorcycle registrations in Florida came from DHSMV while Georgia registration
figures came from FHWA. The ARIMA models explored 78 months prior to the law
change and 30 months after the law change (Figure 10). Partial Autocorrelation
(PACF) and Autocorrelation (ACF) plots were used in determining the order of
components in ARIMA models. At the time of this report, 2002 was the latest year
for which registration data were available. December 2002, therefore, was the
last point of the time series. Florida monthly motorcycle fatalities were modeled using (0, 0,
0) (1, 0, 1) ARIMA; all final PACFs and ACFs were non-significant. The
intervention was statistically significant such that there was an average 9.1
increase in the number of monthly motorcyclist fatalities following the law
change ( p <.001; see Table 6). The specified final ARIMA parameters
were also significant. There was no statistically significant change in the
fatality rate following the same intervention date for Georgia. Change in annual
motorcycle registrations was not a statistically significant parameter in the
final time series model. Table 6. Florida and Georgia Interrupted Time Series
Results State ARIMA Months Significant B T- Approx. Florida (0,0,0) (1,0,1) 78/30 Intervention 9.11 8.91 <.001 Georgia (0,0,0) (0,1,1) 78/30 - - - - Thus, according to time series analysis, controlling for the
annual number of motorcycle registrations, there was a statistically significant
increase in fatalities in Florida following the repeal of the all-rider
motorcycle helmet law. There was no comparable increase in Georgia suggesting
that the Florida result was not due to some coincidental change in the region.
Figure 10. Time Series Motorcycle Fatalities,
Florida versus Georgia (FARS 1994 – 2002) Muller (2004) also used time series methods to study the effects
of Florida's helmet law change and reports a significant intervention effect on
motorcycle fatalities using data for the 72 months before the law change and the
12 month immediately following the change. Stolzenberg and D'Alessio (2003) also
examined Florida motorcycle crash date using a multiple time series design.
Their findings differ from those reported here and by Muller (2004). They
conclude that the repeal of Florida's motorcycle helmet law had little
observable effect on serious injuries or fatalities and, therefore, that the
helmet law change was “inconsequential.” Unfortunately, the analytic design
employed by Stolzenberg and D'Alessio (2003) is methodologically flawed. That
is, they employ fatal and injury crash rates of motorcyclists under the age of
21 as a control series saying, “because the repeal of the motorcycle helmet use
law applied only to motorcycle operators and passengers older than 21 years of
age, the repeal of the law should have little if any effect on the serious
injury and fatality rate series for motorcycle riders younger than 21 years of
age” (p134). As indicated earlier, helmet use among young motorcyclists killed
and injured has decreased markedly since the helmet law change, thereby making
their crash experience unsuitable as an unaffected control series. Helmeted and Non-helmeted Motorcycle Fatalities
. Non-helmeted motorcyclists who were killed in Florida increased
from 15 (9 percent) in 1998 when observed helmet use was close to 100 percent,
to 198 (66 percent) of the total motorcycle fatalities in 2002, an increase of
over thirteen times. When the increase in motorcycle registrations after the law
was changed is taken into account, the non-helmeted fatality rate per 10,000
registered motorcycles increased from 0.7 fatalities in 1998 to 6.1 fatalities
in 2002. Helmeted motorcyclist fatalities, on the other hand,
fell from a rate per 10,000 registered motorcycles of 7.6 in 1998 to 3.2 in
2002. Figures 11 and 12 below show the numbers and rates for helmeted
and non-helmeted Florida motorcyclists who died by year for the 30 months before
and after the law change. Figure 13 shows the changes in the numbers of
motorcyclists killed in the 30 months before and after the law change. Table 7 shows these data for motorcyclists who died at the scene
of the crash and those who were transported to a hospital, but died later, from
1998 through 2002. Of the 301 motorcyclists who died in 2002, two-thirds (198)
were not wearing helmets; 100 of these riders died at the scene of the crash
while 98 died after being transported to a hospital. Of the 173 motorcyclists
who died in 1998, 15 (9 percent) were not wearing helmets; 6 died at the scene
of the crash and 9 died after being transported to a hospital. Table 7. Florida Motorcycle Fatalities, Place of
Death, and Helmet Died 77 44.5% 80 48.8% 47.8% 23.7% 6 3.5% 5 3.0% 5 4.3% 19.8% 1 0.6% 2 1.2% 0 0.0% 0.0% Transported 80 46.2% 71 43.3% 45.2% 9 5.2% 6 3.7% 2.6% 0 0.0% 0 0.0% 0.0% Total 100% 164 100% 100% 100% Injuries Police Crash Reports The Florida Department of Highway Safety and Motor Vehicles
produces an annual database of information taken from police motor vehicle crash
reports. Table 8, compiled from the annual databases, shows the number of
statewide crashes involving motorcyclists, the number of seriously injured
motorcyclists (A-injury), the number of motorcyclists sustaining lesser injuries
(B & C injuries) and the injury rate per 10,000 registered motorcycles. Table 8. All Motorcycle Crashes and Non-Fatal
Injuries, 1994-2001 Year Crashes Involving Motorcycles Motorcyclists A Injuries Motorcyclist B&C Injuries Injuries per 10,000 Registered Motorcycles 1994 5,055 1,507 3,488 281.6 1995 4,887 1,487 3,257 257.1 1996 4,829 1,479 3,442 259.6 1997 4,712 1,432 3,050 230.0 1998 4,536 1,406 2,951 210.1 1999 4,662 1,428 3,037 202.1 2000 5,334 1,576 3,487 210.2 2001 6,069 1,890 3,886 199.3 A-Incapacitating Injury, B-Evident Injury,
C-Possible Injury Figure 14 shows these data graphically. These data
exclude mopeds and all terrain vehicles. In the first full year following the
law change (2001), there were 1,890 motorcyclists who sustained incapacitating
injury and 3,886 who sustained lesser injury. These figures are 32.4 percent
higher and 28.0 percent higher, respectively, than the comparable figures in
1999, but less tha in 1999 when the increase in registrations is taken into
account. Injuries per 10,000 registered motorcycles increased in 2000, but
decreased in 2001. Some of the motorcyclists coded “C—Possible Injury” may not
have sought medical treatment. Table 8 and Figure 15 show that although the
injury rate per registered motorcycle in 2001 is less than the rate in 1999, the
previous downward trend of non-fatal injuries per registered
motorcycle appears to have slowed following the law change period. Hospital Discharge Data The Florida Agency for Health Care Administration
gathers and maintains a hospital discharge database containing information from
the approximately 240 acute care hospitals in the State on cases involving
people admitted for treatment. The annual hospital discharge databases for
1998-2002 were obtained for analysis. The following are the numbers of
motorcyclists admitted for treatment during this period: In the 30 months immediately following the
helmet law change, there were 4,986 motorcyclists admitted to hospitals for
treatment, a figure 40 percent greater than the 3,567 admissions during the 30
months just before the law change. Table 9 shows the distribution by age and gender of
the hospital admitted motorcyclists in the 30 month periods pre and post the law
change. In the pre law change period, 86.4 percent of admissions were males
compared to 87.6 percent in the post law change period, figures that were not
significantly different statistically (chi-square=2.64, df=1, p=0.104). There is a tendency for the post law change
motorcyclists to be slightly older than those in the pre change period. That is,
54.1 percent of the post law injured were age 35 and older compared to 51.6 of
those in the pre change period. The overall age distributions were not
statistically different (chi-square=11.74, df=6, p=0,068), however.
Motorcyclists under the age of 21 made up 12.9 percent and 11.9 percent,
respectively, of pre and post law change injured. Table 10 shows the distributions of principal
diagnosis injury among those admitted in the pre and post law change periods.
The injury distributions before and after the law change differ significantly
(chi-square=39.14, df=5, p<0.001). Injuries to the extremities represented
51.2 percent of the principal injuries in the pre law change period. These
declined to 47.0 percent in the post law change period. Head/brain/skull
injuries represented 16.9 percent of the principal injuries before the law
change and 22.0 percent of the post law change injuries. Gender Stat 1998 1999 2000 2001 2002 Total Pre Post Male % 85.9 86.6 86.4 88.1 87.8 87.1 86.4 87.6 N 1085 1264 1420 1811 1872 7452 3083 4369 Female % 14.1 13.4 13.6 11.9 12.2 12.9 13.6 12.4 N 178 196 223 244 260 1101 484 617 Total % 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 N 1263 1460 1643 2055 2132 8553 3567 4986 Age Stat 1998 1999 2000 2001 2002 Total Pre Post < 21 % 14.3 13.3 11.5 12.1 11.4 12.3 12.9 11.9 N 181 194 189 248 244 1056 461 595 21-24 % 10.4 8.5 9.6 11.5 9.3 9.9 9.3 10.3 N 131 124 158 236 199 848 332 516 25-34 % 25.2 26.8 26.2 23.4 22.8 24.7 26.1 23.6 N 319 391 431 481 487 2109 931 1178 35-44 % 23.4 23.3 24.3 24.4 25 24.2 23.4 24.7 N 296 340 399 501 533 2069 836 1233 45-54 % 16.8 17.4 18 18.2 18.5 17.9 17.5 18.2 N 212 254 296 373 395 1530 623 907 55-64 % 6.5 7.3 7.5 7.3 8.9 7.6 7.3 7.8 N 82 106 123 150 190 651 262 389 65+ % 3.4 3.5 2.9 3.2 3.9 3.4 3.4 3.4 N 43 51 47 66 84 291 123 168 Total % 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 N 1264 1460 1643 2055 2132 8554 3568 4986 As noted, hospital admissions of injured
motorcyclists increased by 40 percent in the post law change period. Head
related injury admissions increased by 82.2 percent followed by internal organ
injuries (48.6 percent). Table 10. Motorcyclists' Principal Diagnosis
Injuries Principal diagnosis is based on the ICD-9-CM coding system and
represents the condition established after study, to be chiefly responsible for
occasioning the admission of the patient to the hospital. Injury Stat 1998 1999 2000 2001 2002 Total Pre Post Extremity % 50.4 51.5 48.4 46.8 48.2 48.8 51.2 47.0 N 637 752 795 961 1,027 4,172 1,827 2,345 Head, Brain, Skull % 14.9 18.0 20.0 21.7 22.2 19.9 16.9 22.0 N 188 263 329 445 474 1,699 602 1,097 Neck, Spine % 2.8 2.0 2.1 2.0 1.9 2.1 2.4 1.9 N 36 29 35 42 40 182 85 97 Internal Organs % 10.9 9.6 9.9 10.6 10.2 10.2 9.9 10.5 N 138 140 162 218 217 875 352 523 Torso Area % 15.6 14.5 14.4 14.4 13.4 14.3 14.8 14.0 N 197 211 237 295 286 1,226 527 699 Other % 5.4 4.5 5.2 4.6 4.1 4.7 4.9 4.5 N 68 65 85 94 88 400 175 225 Total % 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 N 1,264 1,460 1,643 2,055 2,132 8,554 3,568 4,986 Comparing the 30-month periods just before and after
the helmet law change, total gross costs charged to acute care hospital admitted
motorcyclists with a principal diagnosis of head/brain/skull injury more than
doubled from $21 million to $50 million; the average case cost rose by almost
$10,000 (28% increase); the median patient cost increased by almost $4,000 (21%
increase); and the range of costs also increased (see Table 11). Table 11. Head-Brain-Skull Injury Treatment Costs
30 Months Pre Law 30 Months Post Law Total Reported Cost $21,487,186 $50,025,394 Average per Case $35,693 $45,602 Median Charge $18,291 $22,096 Cost Range $3,773-$145,090 $4,976-$178,202 Range is 5 th -95 th percentiles In the post law change period, 75 percent of the
head, brain, skull injured admitted motorcyclists were charged approximately
$12,000 or more (the 75 th percentile) while the remaining 25 percent of
patients were charged less than this amount. That is, less than one-quarter of
the injured would be fully covered by the $10,000 medical insurance requirement
for those who chose not to use helmets. The hospital discharge data indicate that in the post
law change period, approximately 63 percent of admitted motorcyclists were
covered by commercial insurance ($31 million), 16 percent were classified as
“self pay” because they were under insured or uninsured ($8 million), while the
remaining 21 percent had costs ($10.5 million) billed to charitable and public
sources (e.g., Medicaid). During the years following 1998, the Department of
Labor's Consumer Price Index for medical care rose by 3.5 percent in 1999; by
4.1 percent in 2000; by 4.6 percent in 2001; and by 4.7 percent in 2002.
Adjusted for inflation (recalculated in 1998 dollars) the total acute care costs
in the 30 months before the law change for those with a principal diagnosis of
head-brain-skull injury were $20,779,939; an average of $34,518 per case. In
1998 dollars, total acute care costs in the 30 months after the law change were
$43,744,629; an average of $39,877 per case. These figures are shown in Table 12
along with figures for the other principal diagnosis injuries. Principal Diagnosis Number of Cases Cost Per Case 30 Months Pre Law 30 Months Post Law 30 Months Pre Law 30 Months Post Law Head/Brain/Skull 602 1,097 $34,518 $39,877 Extremities 1,827 2,345 $29,110 $32,652 Neck/Spine 85 97 $49,219 $53,194 Internal Organs 352 523 $31,294 $29,933 Torso 527 699 $25,637 $26,159 Other 175 225 $14,794 $15,607 In the 30 months before the helmet law change, 52
motorcyclists with head-brain-skull principal injury died after
admission to an acute care hospital. The average treatment cost for these
cases was $48,126. In the 30 months after the law change, 115 motorcyclists died
following admission. Inflation adjusted costs for these cases averaged $52,450.
In 1998 and 1999, the hospital charges for
head-brain-skull principal injury cases per 10,000 registered motorcycles were
$311,549 and $428,347 respectively. The comparable figures for 2001 and 2002
were $605,854 and $610,386, adjusted for inflation. Other Studies Hotz, et al., (2002), report the results of a
prospective study of injured motorcyclists seen at two Miami-Dade County
(Florida) emergency treatment facilities in the 6 months following repeal of the
State's all-rider helmet law. Comparisons were made with injured motorcyclists
seen in the same period the year before the helmet law change. The basic
findings were that there was an increase in the number of cases seen, a decline
in helmet use among the injured, and an increase in patients who had sustained
brain injury. Treatment costs averaged $41,311 for helmeted motorcyclists and
$55,055 for unhelmeted riders. Hospital length of stay and disability score did
not differ between helmeted and unhelmeted motorcyclists. Hotz et al., (2004) report the results of follow up
interviews with the motorcyclists in the post law change period analyzed earlier
(Hotz et al., 2002). They successfully contacted 48 percent of the injured
motorcyclists at one year post injury and found that 51 percent reported
continuing physical deficits. Only 27 percent continued to ride motorcycles and,
of these, 92 percent were wearing helmets. Summary After the repeal of Florida's universal motorcycle helmet law,
observed helmet use dropped from nearly 100 percent compliance to the 50 percent
range. A post law change survey, done in 2002, found 47 percent compliant helmet
use, 6 percent noncompliant helmet use and 47 percent no helmet use. The use of
compliant helmets has declined following the law change and wearing noncompliant
helmets has largely been abandoned. Non-helmet use among those killed in the three years
before the law change was 9 percent and this increased to 61 percent in the
three years after the law change. Non-helmet use among motorcyclists under the
age of 21 who died was 26 percent in the three years before compared to 45
percent in the three years after the law change, an increase of 188 percent.
Among riders under the age of 21 who sustained incapacitating injuries,
non-helmet use rose from 35 percent in 1999 to 49 percent in 2001. Even though
the law still applied to riders under the age of 21, helmet use dropped for this
age group as well. Motorcycle registrations increased 33.7 percent in
the 30 months after repeal of the law compared to the 30 months before the law
change. There was a 55 percent increase in the average number of motorcyclists
killed in Florida in the same time period. The expected number of motorcycle
fatalities as a result of the increase in registrations was 242. The actual
number who died was 301 in 2002, 59 more motorcycle fatalities than expected as
a result of increased registrations alone (a 24 percent increase). Fatalities in the two years following the law change
were 71 percent greater than those that occurred in the two years before,
compared to an increase of 37 percent for the nation as a whole. Fatalities in
Florida per 10,000 registered motorcycles increased 21 percent compared to 13
percent nationally for the two years before and after the law change. Thus, the
increase in registered motorcyclists alone did not account for the increase in
motorcycle fatalities. Time series analysis showed there was a statistically
significant average 9.1 increase in the number of monthly motorcyclist
fatalities following the law change ( p <.001) in Florida. There was
no statistically significant change in the fatality rate following the same
intervention date for nearby Georgia, which was selected as a comparison State
whose universal helmet law remained unchanged. Change in annual motorcycle
registrations was not a statistically significant parameter in the time series
model. Injuries rose among motorcycle riders. In the first
full year following the law change, the number of motorcyclists who sustained
incapacitating injury rose 32 percent and the number who sustained lesser injury
rose 28 percent than the year before the law change, but less when the increase
in registrations is taken into account. Injuries per 10,000 registered
motorcycles increased in 2000, but decreased in 2001. Although the injury rate
per registered motorcycle in 2001 is less than the rate in 1999, the previous
downward trend of non-fatal injuries per registered motorcycle appears to have
slowed following the law change period. Motorcyclists admitted to hospitals for treatment
rose 40 percent, comparing the 30 months before and after the law change. Head
injury admissions increased by more than 80 percent. Total gross costs charged to hospital admitted
motorcyclists with head, brain or skull injury more than doubled from $21
million to $50 million; the average case cost rose by almost $10,000; the median
patient cost increased by almost $4,000; and the range of costs also increased.
Adjusted for inflation, total acute care hospital costs rose from $21 million to
$44 million and the average cost per case rose from $34,518 to $39,877 in the 30
months after the law change. Less than one-quarter of the head-brain-skull injured
would be covered by the $10,000 medical insurance requirement for those who
chose not to use helmets. About 63 percent of admitted motorcyclists for
head-brain-skull injuries were covered by commercial insurance ($31 million), 16
percent were classified as “self pay” because they were under insured or
uninsured ($8 million), and the remaining 21 percent had their costs ($10.5
million) billed to charitable and public sources (e.g., Medicaid). The number of motorcyclists with head-brain-skull
principal injury who died after admission to an acute care hospital
doubled from 52 to 115, comparing the 30 months before and after the helmet law
change. The average treatment cost for these cases rose from $48,126 to $52,450
(adjusted for inflation) in the same time period. Comparing the years before and after the law change,
the hospital charges for head-brain-skull principal injury cases per 10,000
registered motorcycles were $311,549 (1998) and $428,347 (1999). These costs
rose to $605,854 (2001) and $610,386 (2002). Based on the available evidence it appears likely the increase
in motorcycle fatalities that occurred after the Florida motorcycle helmet law
was repealed was due in part to the reduced use of helmets. Our analysis shows
this is the case despite the pre-existing trend of increasing fatalities, the
increase in fatalities associated with increased exposure (measured by
registrations), the increase in fatalities that occurred in the first six months
of 2000 (before the helmet law repeal became effective), and the likely
contribution of a demographic shift in motorcycle ridership. The effect of the motorcycle helmet law repeal on injuries is
somewhat less clear than the situation for fatalities. Two sources of data were
available: police motor vehicle crash reports, which show an increase in
injuries, but a small decline in injury rates per 10,000 registrations; and
hospital discharge data that show large increases in hospital admissions and
dramatic increases in admissions for head injuries. The weight of the evidence
indicates that the repeal of the helmet law was associated with a slowing of the
existing downward trend in injury rates, with an increase in head injuries. The
cost data show that the total acute care cost more than doubled. As with
fatalities, increased exposure (registrations) cannot account for these
changes.
Florida during the years 1994-2002.
Year
Two Year Average
Percent Change
Fatalities
1994
1995
1996
+15.1%
+7.9%
1997
1998
+5.6%
-4.8%
1999
2000
2001
+71.0%
+20.5%
2002
2003
Model
Pre/Post
Component
Ratio
p
Use (Number and Percentage) FARS 1998-2002
All-Rider Helmet Law
After Law Change
1998
1999
Jan-Jun 2000
Jul-Dec 2000
2001
2002
at Scene Helmeted
55
38
30.2%
65
59
19.6%
Un-helmeted
25
76
27.7%
100
33.2%
Helmet Unknown
0
1
0.4%
0
0.0%
to Hospital
Helmeted
52
31
24.6%
56
20.4%
44
14.6%
Un-helmeted
3
32
25.4%
74
27.0%
98
32.6%
Helmet Unknown
0
0
0.0%
2
0.7%
0
0.0%
173
115
126
100%
274
301
100%
1998
1,263
1999
1,460
2000(Pre law change)
844
2000(Post law change)
799
2001
2,055
2002
2,132
1/1/98-6/30/2000
7/1/2000-12/31/2002