The organization and financing of health services for persons with disabilities

Abstract

Americans with disabilities are rarely considered a distinct group of health care users in the same way as are older Americans, children, racial and ethnic minorities, and others who are perceived to have different needs and access issues. Indeed, to some extent individuals with disabilities overlap with all these groups. But they also have distinct needs with material implications for the organization, delivery, and financing of health care services. Despite the disproportionate health care needs and expenditures of many--though not all--individuals with disabilities, the mainstream health services research community has largely neglected them. This article outlines the most pressing health service research issues in addressing the health care needs of individuals with disabilities.

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Percent of total health care utilization and expenditures by adults with a functional limitation, United States, 1996. A person is defined as having a functional limitation if they fulfill at least one of the following criteria: (1) use mobility aids; (2) have difficulty bending, lifting, or stooping; (3) are limited in their major activity; (4) require help or supervision with ADL/IADL. ░=% of total utilization or expenditure by adults with functional limitations; ♦= people with functional limitations comprise 16.3% of the adult population. Source: Computed by the NRH Center for Health and Disability Research from the March 1996 Medical Expenditure Panel Survey (MEPS).

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Median total and out-of-pocket expenditures for adults, by functional limitation, United States, 1996. Expenditures were computed separately from among individuals with at least a $1 expenditure. A person is defined as having a functional limitation if they fulfill at least one of the following criteria: (1) use mobility aids; (2) have difficulty bending, lifting, or stooping; (3) are limited in their major activity; (4) require help or supervision with ADL/IADL. ░ = adults without functional limitations; █= adults with functional limitation. Source: Computed by the NRH Center for Health and Disability Research from the Medical Expenditure Panel Surveys.

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Payer type by activity limitation among working-age adults, United States, 1996. “Public” insurance coverage refers to Medicare or Medicaid. A person is defined as having an “activity limitation” if they report being limited in their major activity. Approximately 14% of the working-age population is limited in major activity. ░= private; █= public; ░= private and public; ░= uninsured. Source: Computed by the NRH Center for Health and Disability Research from the Medical Expenditure Panel Surveys.

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Payer type by ADL limitation among working-age adults, United States, 1996. “Public” insurance coverage refers to Medicare or Medicaid. A person is defined as having an “ADL limitation” if they report needing assistance with at lease one of six activities of daily living: bathing, dressing, grooming, toileting, eating, and getting around inside the home. Approximately 1% of the working-age population has an ADL limitation. ░= private; █= public; ░= private and public; ░= uninsured. Source: Computed by the NRH Center for Health and Disability Research from the Medical Expenditure Panel Surveys.