OBJECTIVES : We estimate the impact of hospital repatriation on direct healthcare costs, and hospital length of stay (LOS) for Traumatic Brain Injury (TBI) patients living in Ontario, Canada.

METHODS : We used administrative linked individual-level, healthcare utilization records of all legal residents of Ontario between 2010-2018. The specific structure of the data enabled us to address endogeneity concerns via the use of instrumental variables related to the patient`s location of residence combined with a rich set of covariates observed over time.

RESULTS : The study included 36,237 TBI patients. The proportion of repatriated patients between hospitals with different intensities constituted 11% of the data set. Using robust empirical methods, we found that the median difference between direct healthcare costs of repatriated and non-repatriated patients was $14,599.28 (p<0.001). Repatriation status is associated with increased hospital LOS, with a median difference of 2.096 (p<0.001).

CONCLUSIONS : Our results suggest that the existing repatriation mechanism of TBI patients in Ontario might be improved by increasing hospital LOS in high intensity trauma hospitals of TBI repatriated patients. Moreover, we find that, from a social planner's perspective, the gains achieved in increased LOS for an additional day at high intensity trauma hospital far exceed the cost of repatriating TBI patients to general hospital.