Adequacy, equity, efficiency, legal rights, and dynamism in programs for people with traumatic brain injury are examined. Adequacy of services is compromised by costly care, restricted payments by third party carriers, restrictions on the use of available funds, and limited data for judging the types and amounts of services to provide. Compromised adequacy lowers efficiency, raises social costs, and causes horizontal and vertical inequity. Finding less costly and more effective treatment is impeded by a lack of information about the benefits and costs of services, the conservatism of service providers, and financial disincentives to change that are inherent to the existing disability service system. Rigorous research and development are needed to provide a factual basis for federal and state policy making. Greatly improved data are essential to the task of revising the current system of disability programs in the 1990s.
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