Article

OBJECTIVE: To identify insurance provider-related disparities in the receipt of
lightweight, customizable manual wheelchairs or power wheelchairs with
programmable controls among community-dwelling people with spinal cord injury
(SCI). SETTING: Six Spinal Cord Injury Model System centers. DESIGN: A
multicenter cross-sectional study. PARTICIPANTS:
A total of 359 individuals at
least 16 years of age or older and 1 year after SCI who use a manual or power
wheelchair as their primary means of mobility. The subjects were stratified by
payer, and payers were grouped according to reimbursement characteristics as
follows: Medicaid/Department of Vocational Rehabilitation (DVR), private/prepaid,
Medicare, Worker's Compensation (WC)/Veterans Affairs (VA), and self pay.
METHODS: Demographic, wheelchair, and payer data were collected by medical record
review and face-to-face interview. RESULTS: There were 125 participants in the
Medicaid/DVR group, 120 in the private/prepaid group, 55 in the Medicare group,
30 in the WC/VA group, and 29 in the self-pay group. For manual wheelchair users,
the likelihood of having a lightweight, customizable wheelchair was 97.5% for
private/prepaid, 96.3% for Medicaid/DVR, 94.1% for WC/VA, 87.5% for Medicare, and
82.6% for self pay. For power wheelchair users, those with WC/VA (100%) were most
likely to receive a customizable power wheelchair with programmable controls,
followed by private/prepaid (95.1%), Medicaid/DVR (86.0 %), Medicare (83.9%), and
self pay (50.0%). CONCLUSIONS: The only payer group for which all beneficiaries
received wheelchairs that met standard of care were power wheelchairs provided by
WC/VA. Fewer than 90% of people whose manual wheelchair was paid for by Medicare
and self pay, and whose power wheelchair was paid for by Medicaid/DVR, Medicare,
and self pay did not meet standard of care. Although these findings need to be
correlated with long-term risks, such as overuse injuries, breakdowns, and
participation, this study demonstrates that disparities in wheelchair procurement
by insurance provider persist.
CI - Copyright (c) 2014 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS