Article
Access to health care services among people with chronic or disabling conditions: patterns and predictors 1,

https://doi.org/10.1016/S0003-9993(03)00268-5Get rights and content

Abstract

Beatty PW, Hagglund KJ, Neri MT, Dhont KR, Clark MJ, Hilton SA. Access to health care services among people with chronic or disabling conditions: patterns and predictors. Arch Phys Med Rehabil 2003;84:1417–25.

Objective

To examine patterns of access to a variety of specific health care services among people with chronic or disabling conditions, focusing on factors that predict access to services.

Design

National survey of 800 adults with cerebral palsy (CP), multiple sclerosis (MS), spinal cord injury (SCI), or arthritis.

Setting

Respondents were surveyed in the general community.

Participants

National convenience sample of adults with CP, MS, SCI, or arthritis.

Interventions

Not applicable.

Main outcomes measures

Access to services from primary care doctors, services from specialists, rehabilitative services, assistive equipment, and prescription medications. Cross tabulations and logistic regression analyses were performed on survey data to examine patterns and predictors of access to health care services.

Results

Only half of all respondents received needed rehabilitative services. Respondents covered by fee-for-service health plans were more likely than those covered by managed care organizations to receive needed services from specialists. Respondents with the poorest health and with the lowest incomes were the least likely to receive all health services examined.

Conclusions

People with chronic or disabling conditions often require a comprehensive array of health care services. Reform of the current health care payment and delivery structures is needed so that health care is more responsive to those with the greatest service needs.

Section snippets

Sampling

Data for this research came from the first year of a 3-year longitudinal national survey of adults with the following conditions: cerebral palsy (CP), multiple sclerosis (MS), spinal cord injury (SCI), or arthritis (rheumatoid or osteoarthritis). This survey was performed with funding from the National Institute on Disability and Rehabilitation Research as a joint project of the Rehabilitation Research and Training Center on Managed Care and Disability, the Missouri Arthritis Rehabilitation

Differences and similarities between managed care and FFS enrollees

There were several demographic differences between participants who were enrolled in FFS and managed care health plans (table 1). Participants enrolled in managed care plans tended to be younger, less likely to have activity limitations, more likely to be covered by a private insurance plan, more likely to be in a higher income bracket, and more likely to live in the western United States than were those covered by FFS plans. Health plan type was not significantly related to health status,

Discussion

Perhaps the most challenging health care policy issue in the United States is the provision of timely, appropriate, and high-quality health care to its most vulnerable citizens. This study examined variables that may influence access to health care among adults with disabilities or chronic conditions. The results suggest that people with chronic or disabling conditions often require a comprehensive array of health care services but that such care is not consistently available.

The analyses

Conclusion

Health care reform policies aimed at increasing access to services for people with chronic or disabling conditions will not resolve access problems if they focus solely on tightening the reins on MCOs. Relatively large proportions of people with chronic or disabling conditions are still covered by traditional FFS plans. However, neither FFS nor MCO plans have made meaningful changes to increase access to services for members of this population. The unmet needs identified in this study suggest

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    Supported by the National Institute on Disability and Rehabilitation Research, Rehabilitation Research and Training Center on Managed Care and Disability, US Department of Education (grant no. H133B970003), the Missouri Arthritis Rehabilitation Research and Training Center (grant no. H1330980022), and the Rehabilitation Research and Training Center on Health and Wellness (grant no. H133B990019). The contents do not necessarily represent the policy of the US Department of Education or the federal government.

    1

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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