Traumatic brain injury (TBI) presents a major challenge to the health care system because of heterogeneity in cause of injury, severity, prognosis, treatment and outcomes. Although TBI prevention, emergency treatment and acute care are important, effective delivery of long-term services and support are equally necessary and far more complex. The most prevalent health care needs in this population are physical, cognitive, emotional and social needs, followed by needs associated with income and vocational issues. Therefore, a variety of specifically trained health and social services providers must be available; thus coordination across providers and different care levels may be challenging. The high care costs and long rehabilitation are important health care system cost drivers, but rehabilitation interventions often do not specify ingredients that may produce the treatment effects. Knowledge overview from different countries is required to provide more accurate reflections on these issues. The aim of this symposium is to present an international perspective on long-term health care needs after TBI and discuss the challenges and solutions. After a brief introduction, there will be four presentations describing the challenges of outcome evaluation of rehabilitation in the long-term care setting, cost of long-term health care and their predictors, and challenges in long-term care coordination.The last talk will present some of cost-effective options for long-term health care needs after TBI. The information achieved will help to better understanding of patients health care needs, and treatment and rehabilitation strategies in long term perspective after traumatic brain injury. The target audiences of this symposium are clinicians, researchers and policy makers with interest in long-term rehabilitation services for TBI.