Unmet need for disability-related health care services and employment status among adults with disabilities in the Massachusetts Medicaid program

Inpatient healthcare utilization among people with disabilities in Iran: determinants and inequality patterns

BACKGROUND

People with disabilities (PWD) have different health service needs and different factors affect the utilization of these services. Therefore, the aim of this present study was to identify determinants of inpatient healthcare utilization among PWDs in Iran.

METHODS

This research was a secondary data analysis of a cross-sectional study. The present study used data gathered for 766 PWDs (aged 18 years and older) within the Iranian Society with Disabilities (ISD) between September and December 2020. Multiple logistic regression models calculated adjusted odds ratios (aOR) and 95% confidence intervals in order to identify determinants of inpatient healthcare utilization among PWDs.

RESULTS

Data for 766 people with disabilities were analyzed. A large number of participants were over 28 years of age (70.94%), male (64.36%), and single (54.02%). In the present study, more than 71% of participants had no history of hospitalization during the last year. In this study, males [aOR 2.11(1.14-3.91), participants with Civil Servants health insurance coverage [aOR 3.44 (1.16 - 10.17)] and individuals in the 3th quartile of disability severity [aOR 2.13 (1.01 - 4.51)] had greater odds of inpatient healthcare utilization compared to the other groups. The value of the concentration index (C) for inpatient healthcare utilization was - 0.084 (P.value = 0.046). The decomposition analysis indicated that gender was the greatest contributor (21.92%) to the observed inequality in inpatient healthcare utilization among participants.

CONCLUSION

Our findings suggested that the likelihood of hospitalization among the study participants could be significantly influenced by factors such as gender, the health insurance scheme, and the degree of disability severity. These results underscore the imperative for enhanced access to outpatient services, affordable insurance coverage, and reduced healthcare expenditures for this vulnerable population. Addressing these issues has the potential to mitigate the burden of hospitalization and promote better health outcomes for disadvantaged individuals.

It’s time for the NIH to formally designate people with disabilities as a US health disparity population

This commentary discusses the implications of the report and recommendations of the Working Group on Diversity's Subgroup on Individuals with Disabilities, recently endorsed by the full Advisory Committee to the Director (ACD) of the National Institutes of Health (NIH). We suggest that one of these recommendations, the formal designation of people with disabilities as a US health disparity population, can be enacted immediately, which would spur new federal investment in disability-based disparities research.

Access to Mental Healthcare in the 21st Century: An Evolutionary Concept Analysis

BACKGROUND

One of the most important aspects of receiving medical care is access to that care. For people with mental illness who have greater healthcare needs and are at risk for poor health outcomes, reduced access to care constitutes a crisis. While the COVID-19 (coronavirus disease 2019) pandemic continues to affect the United States, specifying what it means to have access to mental healthcare is more critical than ever.

AIMS

The aims of this concept analysis are to review definitions and descriptions of access to mental healthcare in the literature and to synthesize the relevance of these findings to inform future research, theory development, policy, and practice.

METHODS

The concept of access to mental healthcare was analyzed using Rodgers's evolutionary concept analysis method. CINAHL, PsycINFO, and MEDLINE were queried for peer-reviewed articles about access to mental healthcare published from January 2010 to April 2020 (n = 72). Data were reviewed for concept antecedents, attributes, consequences, surrogate, and related terms.

RESULTS

Five models of access to mental healthcare were identified, with several antecedents and consequences: utilization, economic loss/gain, incarceration, and patient/provider satisfaction. Cross-sectional and predictive studies highlighted three interrelated attributes: clinical management, healthcare delivery, and connectedness.

CONCLUSIONS

The concept of access to mental healthcare is often used stagnantly across disciplines to create health policies, yet the concept is transformative. Future research requires up-to-date operational definitions of access to mental healthcare to target interdisciplinary approaches.

Satisfying medical and rehabilitation needs positively influences returning to work after a work-related injury: an analysis of national panel data from 2018 to 2019

Background

This study examined how meeting the medical needs of injured workers after initial treatment may affect their return to work, using data from the Panel Study of Workers’ Compensation Insurance.

Methods

This study was designed as a longitudinal study, which used data from the second-year, follow-up survey conducted in the secondary cohort of the Panel Study of Workers’ Compensation Insurance. The odds ratio (OR) and 95% confidence interval were estimated through binomial and multinomial logistic regression analyses to examine the effects of unmet medical needs on workers’ return to original work and return to work overall (including reemployment).

Results

The returned to original work OR of workers whose rehabilitation needs were met was 1.35 (1.12–1.63) while the return to work OR was 1.20 (1.03–1.41). The returned to original work OR of workers whose medical needs were met was 1.64 (1.18–2.27) while the return to work OR was 1.39 (1.07–1.80). In terms of disability rating, the return to work ORs of workers with mild disabilities whose medical/rehabilitation needs were not met and those of workers without disabilities were 1.71 (1.17–2.49) and 1.97 (1.27–3.08), respectively. In the case of regular/temporary workers, the returned-to-work ORs of workers whose medical/rehabilitation needs were not met were 1.54 (1.12–2.13) and 1.27 (1.03–1.56), respectively.

Conclusions

For workers who sustained work-related injuries, providing medical accessibility and meeting rehabilitation needs were found to be important predictors of return to work after initial treatment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12064-1.

Meagreness of Employees Is Symptomatic to Disease: A Case on Healthcare Industry

The main purpose of this study is to examine the existing workplace scenario in the healthcare industry. Furthermore, it analyses the causes and also uncovers the solutions to resolve the attrition problem confronted by the healthcare industry in India. The authors have explored the attrition phenomenon through a conceptual descriptive study conducted with the support of secondary data. The variables that play their noticeable role are lack of work-life balance, the absence of the feeling of achievement among the workers, substantial outstanding burden with nearly less remuneration and furthermore much repetitiveness of work. To conquer such situations, the organisation should work upon their inward strategies including the policies formed in consensus with the employees, increased employee participation in decision making and last but not the least, the organisation ought to introduce the mentoring programme with consistency, which will manufacture the trust among the lower level workers. The results of this study will be of interest to the modern HR world, HR and healthcare students, hospital administrators and to any HR consultant or agency wishing to study and resolve the herculean issue of attrition that obstructs the walls of organisational development.

Forgone Medical Care Associated With Increased Health Care Costs Among the U.S. Heart Failure Population

OBJECTIVES

The objective of this study was to describe the prevalence of patients with forgone/delayed care for heart failure (HF) and examine the associated demographic characteristics, health care utilization, and costs.

BACKGROUND

HF is a leading cause of morbidity and mortality, with health care expenditures projected to increase 3-fold from 2012 to 2030. The proportion of HF patients with forgone/delayed medical care and the association with health care expenditures and utilization remain unknown.

METHODS

Data on patients with HF were obtained from the Medical Expenditure Panel Survey to assess expenditures and health care utilization in the United States from 2004 to 2015. Patients with HF who reported forgone/delayed care, any missed or delayed medical treatment, were compared with those without care lapses.

RESULTS

Overall, 16% of patients with HF reported forgone/delayed care, including 10% among the elderly (aged ≥65 years) and 27% among the nonelderly (age <65 years). Patients with HF who reported forgone/delayed care had annual health care expenses $8,027 (95% CI: $1,181-$14,872) higher than those who did not. Among the elderly, those reporting forgone/delayed care had more emergency department visits (43% vs 58%; P < 0.05), and had higher annual inpatient costs (+$7,548; 95% CI: $1,109-$13,988) and total health care costs (+$10,581; 95% CI: $1,754-$19,409). Sixty percent of nonelderly and 46% of elderly patients with HF reported deferring care due to financial barriers.

CONCLUSIONS

Nearly 1 in 6 patients with HF in the United States reported forgone/delayed medical care, with one-half attributing it to financial reasons, and this was associated with higher overall health care spending.

Demographics and Durable Medical Equipment Needs of Persons With Disabilities in a Charitable Rehabilitation Clinic

ABSTRACT

This study characterizes the demographics and durable medical equipment needs of persons with disabilities to improve utilization and management of resources at a philanthropic rehabilitation clinic. Paper charts from all encounters between 2013 and 2018 were reviewed. Data collected include sex, age, ethnicity, insurance status, diagnoses, and durable medical equipment requested/received. Paper charts that were incomplete or illegible were excluded. Among 763 individuals, there were 1157 encounters for durable medical equipment requests. Forty-six percent of individuals were uninsured. Thirty-seven percent had federal insurance such as Medicare or Medicaid, and 6% private insurance. Fifty-five percent of individuals were Hispanic, 28% African American, and 14% White. Fifty-six percent of encounters were with individuals with a neurological diagnosis, 18% medical diagnosis, 17% musculoskeletal/autoimmune diagnosis, 6% amputation diagnosis, and 3% cancer diagnosis. Of the 2680 items distributed, 34% were wheelchair parts and repair, 30% personal hygiene/incontinence supplies, 25% mobility equipment, and 11% bathroom equipment. Of the 513 unmet items requested, 49% were mobility equipment, 24% wheelchair parts and repair, 17% personal hygiene/incontinence supplies, and 11% bathroom equipment. More than a third (43%) of durable medical equipment requests were from individuals with either private insurance or federal payers, which implies lack of adequate coverage on durable medical equipment to maintain mobility and independence.

Investigating similarities and differences in health needs according to disability type using the International Classification of Functioning, Disability and Health

Purpose: This study aimed to investigate the health needs of adults with disabilities in South Korea according to disability type using the International Classification of Functioning, Disability and Health (ICF).Materials and methods: An exploratory, qualitative approach using content analysis was employed. Five focus groups consisted of six to seven participants with visual impairment (PVI), hearing impairment (PHI), physical impairment (PPI), brain disorder (PBD), and intellectual disability (PID). Linking rules were used to identify how the health needs related to the ICF components of Body Functions, Activity & Participation, and Environmental Factors.Results: The health needs related to the Environmental Factors were the most mentioned and were frequently perceived as causes of poor health conditions related to Activities & Participation and Body Function. According to what participants perceived as main health issues in the Environmental Factors, the five groups were classified into (1) Services, systems, and policies mainly affecting type (PVI and PPI); (2) Support and relationships mainly affecting type (PHI); and (3) Attitude mainly affecting type (PBD and PID).Conclusions: Government officials and health professionals must tailor development and provision of healthcare for people with disabilities based on health need type.IMPLICATIONS FOR REHABILITATIONFew studies have investigated the health needs of people with disabilities, although many health indicators suggest that they are facing health inequalities in South Korea.The health issues related to the Environmental Factors were often perceived in this study as causes of poor health conditions related to the Activities & Participation and Body Function, indicating the need to preferentially solve the health issues related to the Environmental Factor.According to what people with each of the five types of disabilities perceived as main health issues and what kinds of actions they expected in the Environmental Factors, they could be classified into three health need types.It is recommended that government officials and health professionals develop and provide appropriate supply-side measures of healthcare considering these different demand-side health needs according to disability type.

Hearing loss and employment: a systematic review of the association between hearing loss and employment among adults

Background

Hearing loss affects over 1.3 billion individuals worldwide, with the greatest burden among adults. Little is known regarding the association between adult-onset hearing loss and employment.

Methods

Seven databases (PubMed, Embase, Cochrane Library, ABI/Inform Collection, Business Source Ultimate, Web of Science and Scopus) were searched through to October 2018. The key word terms used related to hearing loss and employment, excluding paediatric or congenital hearing loss and deaf or culturally deaf populations.

Results

The initial search resulted in 13 144 articles. A total of 7494 articles underwent title and abstract screening, and 243 underwent full-text review. Twenty-five articles met the inclusion criteria. Studies were set in 10 predominantly high-income countries. Seven of the 25 studies analysed regionally or nationally representative datasets and controlled for key variables. Six of these seven studies reported associations between hearing loss and employment.

Conclusion

The highest quality studies currently available indicate that adult-onset hearing loss is associated with unemployment. However, considerable heterogeneity exists, and more rigorous studies that include low- and middle-income countries are needed.

Association of Expanded Medicaid Coverage With Health and Job-Related Outcomes Among Enrollees With Behavioral Health Disorders

OBJECTIVES

The study objective was to assess the impact of Medicaid expansion on health and employment outcomes among enrollees with and without a behavioral health disorder (either a mental or substance use disorder).

METHODS

Between January and October 2016, the authors conducted a telephone survey of 4,090 enrollees in the Michigan Medicaid expansion program and identified 2,040 respondents (48.3%) with potential behavioral health diagnoses using claims-based diagnoses.

RESULTS

Enrollees with behavioral health diagnoses were less likely than enrollees without behavioral health diagnoses to be employed but significantly more likely to report improvements in health and ability to do a better job at work. In adjusted analyses, both enrollees with behavioral health diagnoses and those without behavioral health diagnoses who reported improved health were more likely than enrollees without improved health to report that Medicaid expansion coverage helped them do a better job at work and made them better able to look for a job. Among enrollees with improved health, those with a behavioral health diagnosis were as likely as those without a behavioral health diagnosis to report improved ability to work and improved job seeking after Medicaid expansion.

CONCLUSIONS

Coverage interruptions for enrollees with behavioral health diagnoses should be minimized to maintain favorable health and employment outcomes.

Insurance coverage and access to care for workers with disabilities, 2001-2017

BACKGROUND

Workers with disabilities have different options than their peers for obtaining health insurance, and face unique barriers in accessing care. The Patient Protection and Affordable Care Act (ACA) led to sweeping changes in the availability and affordability of health insurance in the United States beginning in 2010, and may have had important effects for workers with disabilities.

OBJECTIVE/HYPOTHESIS

Document how the ACA changed insurance coverage and access to care for workers with disabilities, and compare those changes to changes among other groups.

METHODS

We document health insurance coverage and access to care among workers with disabilities using the 2001-2017 National Health Interview Survey.

RESULTS

The share of insured workers with disabilities increased from 79.9% in 2009 to 87.8% in 2017. This gain resulted from an 11 percentage point (pp) increase in the share with Medicaid coverage in 2014-2017 compared with 2001-2009 and a 5 pp increase in privately purchased coverage over those periods. These were accompanied by an 11 pp decline in the share with employer-sponsored coverage. Despite coverage gains, cost-related barriers to accessing medical care did not change much after the ACA, for any group. Workers with disabilities experienced an increase in structural access barriers, from 18.4% before the ACA to 24.8% after.

CONCLUSIONS

The gain in insurance coverage for workers with disabilities is an important benefit of the ACA, but more investigation and monitoring should be considered to understand whether such coverage will translate into improvements in access to needed health care.

The relationship between employment and health and health care among working-age adults with and without disabilities in the United States

Purpose: To better understand the relationship between employment and health and health care for people with disabilities in the United States (US). Methods: We pooled US Medical Expenditure Panel Survey (2004-2010) data to examine health status, and access to health care among working-age adults, comparing people with physical disabilities or multiple disabilities to people without disabilities, based on their employment status. Logistic regression and least squares regression were conducted, controlling for sociodemographics, health insurance (when not the outcome), multiple chronic conditions, and need for assistance. Results: Employment was inversely related to access to care, insurance, and obesity. Yet, people with disabilities employed in the past year reported better general and mental health than their peers with the same disabilities who were not employed. Those who were employed were more likely to have delayed/forgone necessary care, across disability groups. Part-time employment, especially for people with multiple limitations, was associated with better health and health care outcomes than full-time employment. Conclusion: Findings highlight the importance of addressing employment-related causes of delayed or foregone receipt of necessary care (e.g., flex-time for attending appointments) that exist for all workers, especially those with physical or multiple disabilities. Implications for rehabilitation These findings demonstrate that rehabilitation professionals who are seeking to support employment for persons with physical limitations need to ensure that overall health concerns are adequately addressed, both for those seeking employment and for those who are currently employed. Assisting clients in prioritizing health equally with employment can ensure that both areas receive sufficient attention. Engaging with employers to develop innovative practices to improve health, health behaviors and access to care for employees with disabilities can decrease turnover, increase productivity, and ensure longer job tenure.

Disparities in Insurance Coverage, Health Services Use, and Access Following Implementation of the Affordable Care Act: A Comparison of Disabled and Nondisabled Working-Age Adults

The objective of this study was to assess trends in health insurance coverage, health service utilization, and health care access among working-age adults with and without disabilities before and after full implementation of the Affordable Care Act (ACA), and to identify current disability-based disparities following full implementation of the ACA. The ACA was expected to have a disproportionate impact on working-age adults with disabilities, because of their high health care usage as well as their previously limited insurance options. However, most published research on this population does not systematically look at effects before and after full implementation of the ACA. As the US Congress considers new health policy reforms, current and accurate data on this vulnerable population are essential. Weighted estimates, trend analyses and analytic models were conducted using the 1998-2016 National Health Interview Surveys (NHIS) and the 2014 Medical Expenditure Panel Survey. Compared with working-age adults without disabilities, those with disabilities are less likely to work, more likely to earn below the federal poverty level, and more likely to use public insurance. Average health costs for this population are 3 to 7 times higher, and access problems are far more common. Repeal of key features of the ACA, like Medicaid expansion and marketplace subsidies, would likely diminish health care access for working-age adults with disabilities.

Expenditures and use of wraparound health insurance for employed people with disabilities

BACKGROUND

The Affordable Care Act (ACA) provides health insurance to many working-age adults with disabilities, but we do not expect the new coverage or existing insurance options to fully meet their employment-related health care needs. Wraparound services have the potential to foster employment among people with disabilities.

OBJECTIVE

We use Massachusetts, which implemented health care reform in 2006, as a case study to estimate the wraparound health care expenditures and use for workers with disabilities.

METHODS

We identified a group of employed, working-age people with disabilities whose primary health insurance is Medicare or private insurance and who use the Medicaid Buy-In Program for wraparound coverage. We analyzed claims to estimate expenditures and use.

RESULTS

Wraparound expenditures averaged $427 per member per month. Community-based services for both mental and non-mental health, which are generally not covered by Medicare or private insurance, accounted for 63% of all expenditures. The number who used community-based services was low, but the expenditures were high. The majority of the remaining expenditures were for services usually covered by primary insurance including: inpatient and outpatient, pharmacy and professional services. Expenditures were higher for people with Medicare compared to private insurance.

CONCLUSIONS

This case study suggests that, from a total program cost perspective, wraparound demand is greatest for community-based services. From a member utilization perspective, the demand is greatest for coverage that alleviates out-of-pocket costs for services provided by primary insurance. Additional analysis is needed to further assess the design options for wraparound programs and their feasibility.

Examining access to care for younger vs. older dual-eligible adults living in the community

BACKGROUND

Recent state dual-eligible (Medicare and Medicaid) payment reform demonstrations have included groups of both working-age and older adults, but relatively little is known about how access to care varies between these two populations.

OBJECTIVES/HYPOTHESIS

To examine access to a usual source of care for younger and older dual-eligible adults, to analyze whether timely access to several types of care differed in these two populations, and to understand some of the underlying reasons for delayed care among younger and older dual-eligibles.

METHODS

Using observations pooled across calendar years 2003-2012 of the Medical Expenditure Panel Survey, this study conducted descriptive and multivariate analyses to examine access to care measures.

RESULTS

Younger dual-eligible adults were more likely to encounter problems with accessing medical care, dental care, and prescription medications than older dual-eligible adults. Both groups of dual-eligible adults reported that a lack of affordability, gaps in existing insurance coverage, and difficulty in getting to a provider's office were the most common reasons for delayed access to care.

CONCLUSIONS

A lack of affordability for medical care, dental care, and prescription medications suggests that high co-payments and cost sharing for some services may be deterring access to needed care. Younger dual-eligibles were more likely to encounter service coverage gaps than older dual-eligibles. States should monitor Medicare-Medicaid plans to confirm they have adequate provider networks.

Health services appraisal and the transition to Medicaid Managed Care from fee for service

BACKGROUND

Many states are transitioning fee-for-service (FFS) Medicaid into Medicaid Managed Care (MMC) for people with disabilities.

OBJECTIVE

This study examined managed care's impact on health services appraisal (HSA) and unmet medical needs of individuals with disabilities receiving Medicaid. Key questions included 1) Do participant demographics and enrollment in MMC impact unmet medical needs and HSA? 2) Within MMC, do demographics and continuity of care relate to unmet medical needs? 3) Within MMC, do demographics, unmet medical needs and continuity of care relate to HSA?

METHODS

We collected cross-sectional survey data (n = 1615) from people with disabilities in MMC operated by for-profit insurance companies (n = 849) and a similar group remaining in FFS (n = 766) in one state. Regression analyses were conducted across these groups and within MMC only.

RESULTS

Across Medicaid groups, MMC enrollment was not related to either HSA or unmet needs; health status, having a mental health disability and unmet transportation needs related to HSA and health status, unmet transportation needs and having a mental health or physical disability related to higher unmet medical needs. Within MMC, in addition to better health and fewer unmet medical needs, less continuity of care significantly decreased HSA. Higher unmet transportation needs, poorer health status, having a physical or mental health disability, and less continuity of care significantly decreased unmet medical needs.

CONCLUSIONS

This research points to the importance of meeting unmet needs of individuals in MMC and the need for increased continuity of care as people transition from FFS.

Gaps in Timely Access to Care Among Workers by Disability Status

The Patient Protection and Affordable Care Act (ACA) is salient for workers with a disability because of their significant health care needs, relatively low incomes, and the complex interactions among work, federal disability benefits, and eligibility for public health insurance. Using data from the 2006–2010 National Health Interview Surveys, in this study, we document the characteristics and health insurance profiles of workers with a disability and consider the extent to which these factors are correlated with the ability to access adequate and timely health care. We find significantly higher rates of reported difficulties accessing timely health care for cost-related and structural reasons among employed adults with self-reported health conditions limiting the ability to work than among their non-work-limited peers, even after controlling for personal characteristics and health insurance coverage. The findings suggest that although the ACA will improve access to health insurance, it remains to be seen whether it will substantially reduce the likelihood that workers with disabilities will experience barriers to health care access relative to their non-disabled peers.

Employment-Related Health Insurance and Service Delivery Needs of Persons With Disabilities

The health care reforms underway in the United States will benefit persons with disabilities; however, the reforms may not fully support the employment-related needs of persons with disabilities. Secondary health insurance to wrap around primary coverage may be a viable policy solution to meet the needs. This article identifies and examines the employment-related health insurance, health care, and service delivery needs of employed and potentially employed persons with disabilities. We conducted six focus groups with 54 working-age, insured, employed, and potentially employed persons with disabilities in Massachusetts. Participants reported unmet needs, high out-of-pocket costs, or a burden to manage their health care, disability, and employment. The needs included services currently limited by insurance plans, long-term services and supports, other disability services, care coordination, and cost protections. The data suggest that the combined needs are highest for persons working full-time or near full-time, and the unmet needs are lower for persons with Medicaid secondary coverage. The results suggest that full-time or near full-time workers are an important subgroup for wrap-around coverage; such coverage could potentially alleviate costs and increase work incentives among this subgroup. Additional research is needed to quantify the needs and to assess the design options for a wrap-around program.

Access to medical services in korean people with spinal cord injury

Objective

To investigate the accessibility of medical services for Korean people with spinal cord injury (SCI) compared to the control group (CG) and to evaluate significantly related factors.

Methods

A total of 363 community dwelling people with chronic SCI were enrolled and 1,089 age- and sex-matched subjects were randomly selected from the general population as the CG. Self-reported access to medical services was measured by asking "Have you experienced the need for a hospital visit in the last year but could not?". This was followed up by asking the reasons for not receiving services when medically necessary. Variables, including lack of finances, difficulties making medical appointments, and lack of transportation were evaluated for accessibility to medical services.

Results

Sixty subjects (16.5%) in the SCI group had difficulties receiving medical services due to a lack of accessibility, compared to 45 (4.1%) in the CG (p<0.001). Variables causing difficulties receiving medical services were lack of transportation (27 persons, 45%), lack of finances (24 persons, 40%), and difficulty scheduling hospital appointments (9 persons, 15%) in the SCI group. In the CG, availability (lack of available time) and acceptability (deciding not to visit the hospital due to mild symptoms) were the reasons for not receiving medical care.

Conclusion

People with SCI experienced limited accessibility to medical services, which was due to environmental rather than personal factors compared to that in the CG. Therefore, development of social policies to reduce or remove environmental variables is necessary.

Undermet needs for assistance in personal activities of daily living among community-dwelling oldest old in China from 2005 to 2008

Based on the 2005 and 2008 Chinese Longitudinal Healthy Longevity Survey, this study examined the prevalence of undermet needs for assistance in personal activities of daily living (ADL) and its associated risk factors among the oldest old aged 80+. Multilevel multinomial logistic modeling was used to analyze the risk factors and changes of undermet needs over time. The results show that the prevalence of slightly undermet needs decreased in urban China from 2005 to 2008. However, the prevalence of undermet needs remained high; 50% or more for both rural and urban residents. Compared to 2005, the likelihood of having slightly undermet needs in 2008 significantly decreased by 28% among rural residents and 22% among urban residents. The common risk factors of undermet needs among rural and urban residents included financial dependence, living alone, having unwilling caregivers, more ADL disabilities, and having poor self-rated health.

Use of emergency departments among working age adults with disabilities: a problem of access and service needs

OBJECTIVE

To examine the relationship between emergency department (ED) use and access to medical care and prescription medications among working age Americans with disabilities.

DATA SOURCE

Pooled data from the 2006-2008 Medical Expenditure Panel Survey (MEPS), a U.S. health survey representative of community-dwelling civilians.

STUDY DESIGN

We compared the health and service utilization of two groups of people with disabilities to a contrast group without disability. We modeled ED visits on the basis of disability status, measures of health and health conditions, access to care, and sociodemographics.

DATA EXTRACTION

These variables were aggregated from the household component, the medical condition, and event files to provide average annual estimates for the period spanning 2006-2008.

PRINCIPAL FINDINGS

People with disabilities accounted for almost 40 percent of the annual visits made to U.S. EDs each year. Three key factors affect their ED use: access to regular medical care (including prescription medications), disability status, and the complexity of individuals' health profiles.

CONCLUSIONS

Given the volume of health conditions among people with disabilities, the ED will always play a role in their care. However, some ED visits could potentially be avoided if ongoing care were optimized.

Brief report: the medical care of adults with autism spectrum disorders: identifying the needs

There is a lack of information concerning adults with autism spectrum disorder (ASD), especially with regards to their access to health care. A paper and electronic survey was sent to 1,580 primary care physicians in Connecticut. 346 respondents returned a survey and provided care to adults with an ASD. This physician survey provides data on adults with ASD such as: reasons for physician visits, living arrangements, employment status, and any services they are receiving. Responses revealed inadequate training in the care of adults with an ASD and physicians interest in obtaining additional training. The ability to provide a medical home for adults with autism will need to address effective strategies to train current and future physicians.

Return to work: a critical aspect of care coordination for younger dual eligibles

BACKGROUND

Annual health care costs for dual eligibles now top $300 billion. Many dual eligibles are under age 65 and their needs differ significantly from retired elderly dual eligibles. For younger dual eligibles, successful return to work is an important objective for coordinated care.

OBJECTIVES

To assess relative rates of dual eligibility by age group and program enrollment (SSDI or OASI), and to identify the prevalence among these subgroups of factors associated with return to work.

METHODS

Population estimates and logistic regression analysis of the 2010 Medicare Current Beneficiary Survey (MCBS).

RESULTS

Although they make up only 16% of the total Medicare beneficiary population, disabled workers under age 65 constitute 42% of all dual eligibles. SSDI beneficiaries under age 45 have 20 times greater odds of receiving Medicaid benefits compared to retirees (AOR = 19.8, 95% CI = 16.2-24.2). The youngest dual eligible adults are more likely to work, have fewer chronic conditions, and report better health status than other dual eligibles. However, they are more likely to report problems with obtaining health care and be dissatisfied with the quality of the care they receive.

CONCLUSIONS

Dual eligible workers with disabilities are an important target population for coordinated services because of their high lifetime program costs - many will receive SSDI, SSI, Medicare, and Medicaid benefits for decades. Return to work and continued employment are important policy objectives for younger dual eligibles and should provide the greatest return in terms of reduced dependence on federal disability programs.