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PubMed2002

Health insurance for unemployed workers.

OBJECTIVE: In this article, we seek to inform the debate over providing assistance to workers who lose their jobs during the recession by assessing the potential impact of an economic downturn on health insurance coverage and reviewing available approaches to secure coverage for unemployed workers and their families. We also summarize recent research and analysis to examine the likely challenges and benefits of these approaches. DATA SOURCE: Data and analysis are primarily based on the Census Bureau's Current Population Survey, the Urban Institute's National Survey of America's Families, and Medicaid data from the Centers for Medicare and Medicaid Services. We also draw on recent surveys and analysis conducted by researchers in the health policy field. CONCLUSIONS: Maintaining health insurance coverage for unemployed workers is important to helping individuals and to stimulating our economy. While some families may be assisted by efforts to subsidize COBRA extension coverage, the potential reach of such an initiative is limited. Building on public programs such as Medicaid offers a targeted, efficient, and effective option but also presents financing challenges to federal and state governments.

Humans↗
PubMed1996

Racial differences in survival from gynecologic cancer.

OBJECTIVE: To determine whether survival from gynecologic cancer is different between African-American and white patients at an inner-city hospital with both a large clinic and a private service. METHODS: We studied 538 patients (89 African American, 449 white) diagnosed with cervical, uterine, or ovarian cancer at a single institution from January 1, 1989 through December 31, 1993. Information was obtained on age, stage, site of disease, histology, and type of health insurance (public or commercial). Insurance coverage was used as a proxy for socioeconomic status. Overall survival was estimated by the method of Kaplan and Meier and compared by the log-rank test. Cox proportional hazard modeling was used to evaluate the effects of multiple factors on survival. RESULTS: African-American patients were significantly older and were more likely to have cervical cancer and public insurance than white patients. Overall survival was worse for African-American patients than for white patients (P < .05). However, stage for stage, there was no significant difference in survival between the groups. There was also no difference when patients were grouped by insurance status. African Americans had a significantly worse survival for cervical cancer than whites, and African-American patients older than 65 years had a worse survival than whites of similar age. On multivariate analysis, only stage and insurance coverage were significant predictors of survival. CONCLUSIONS: African-American patients with gynecologic cancer at our institution have worse overall survival than white patients. The survival difference seems to be due predominantly to differences in socioeconomic status and stage at diagnosis.

Black People↗
PubMed2003

Utilization of dental care services by Asians and native Hawaiian or other Pacific Islanders: United States, 1997-2000.

OBJECTIVE: This report describes national estimates of dental care service utilization and unmet dental care needs due to cost for six Asian ethnic subgroups and the native Hawaiian or other Pacific Islander (NHOPI) population. METHODS: Combined data from the 1997-2000 National Health Interview Surveys (NHISs), conducted by the Centers for Disease Control's National Center for Health Statistics, were analyzed to produce estimates for Asians and NHOPIs aged 2 years and over. Information on dental care service utilization and unmet dental care needs due to cost was self-reported by persons aged 18 years and over. For children aged 2-17 years, the information was collected from an adult who was knowledgeable about the child's health. RESULTS: Approximately 64% of Asian and 56% NHOPI persons had visited a dentist at least once in the past year. Utilization of dental care services, however, varies significantly by ethnic subgroup. Asian Indians were most likely to have never had a dental visit and the NHOPIs were most likely to experience unmet dental care needs in the past year. Among adults, Japanese Americans (68.2%) were most likely and NHOPIs (49.3%) were least likely to have had a dental visit in the past year. Underutilization of dental care services was most prevalent among Asian adults with poor or near poor poverty status, without health insurance coverage, and who had resided in the United States for less than 5 years. Among children, NHOPIs (82.0%) were most likely and Asian Indians (60.1%) were least likely to have had a dental visit in the past year. Underutilization was most prevalent among Asian children who were not living with their parents or living with a single parent, who had no insurance coverage, who had poor or near poor poverty status, and whose parents had less than 12 years of education. CONCLUSIONS: Utilization of dental care services and unmet dental care needs due to cost vary among the Asian ethnic subgroups and the NHOPI population.

Adolescent↗
PubMedDate not supplied

Differences in health insurance and health service utilization among Asian Americans: method for using the NHIS to identify unique patterns between ethnic groups.

The purpose of this study is to outline a method to identify the characteristics of socioeconomic variables in determining the differences in health insurance coverage and health services utilization patterns for different ethnic groups, using the behavioural model of health service utilization. A sample drawn from Asian American adult respondents to the 1992, 1993, and 1994 National Health Interview Surveys (NHIS) in the USA formed the data set. The results showed Asian Americans as not being homogeneous. There were distinctly different demographic and socioeconomic characteristics between six Asian American ethnic groups that affect health insurance coverage and health service utilization. The study method is useful for constructing health policy and services to address the general public need without adversely affecting smaller minority groups. Secondary analysis of well-constructed national data sets such as the specific Asian ethnic groups in NHIS, offers a rich method for predicting the differential impact of specific health policies on various ethnic groups.

Adolescent↗
PubMed2005

Colorectal cancer screening behavior and health insurance status (United States).

OBJECTIVE: The purpose of this study was to examine the association between health insurance status and CRC screening behavior among a diverse sample of ambulatory patients. METHODS: Cross-sectional, retrospective study. Quota sampling techniques were used to recruit 52 insured/uninsured patients > or =age 50 from three Midwestern medical clinics (N=104). Data were collected by interviewer-administered CRC screening questionnaires. RESULTS: Thirty-nine percent of the sample was in compliance with CRC testing guidelines. Insured compared to uninsured participants were significantly more likely to have ever completed any testing (77% versus 33%), and were more likely to have undertaken testing according to current US guidelines (62% versus 17%), all ps < 0.001. Insured participants also were significantly more likely than the uninsured to know about, receive physician recommendation to screen, and profess future intent to screen, ps < 0.001. Fewer uninsured participants were tested for routine reasons compared to insured participants. Significant group differences did not emerge on future preference for a particular screening methodology, if testing costs were equal. CONCLUSIONS: Results suggest that CRC screening depends, in part, on health insurance status. Increasing insurance coverage or resources for low-cost, accurate tests may facilitate future screening.

Aged↗
PubMed2003

Insurance status of HIV-infected adults in the post-HAART era: evidence from the United States.

In the United States, universal public insurance is only available for the elderly. But unlike most other major diseases, HIV/AIDS predominantly affects the nonelderly. The result is that insurance availability and public programme participation are linked to disease progression in a complicated way. This paper uses data from a unique, nationally representative sample of HIV-infected adults receiving medical care, to describe the relationship between disease progression and insurance coverage in the United States. We find that public insurance is the predominant source of coverage for those in care for HIV, and that coverage increases as disease progresses. Those with public coverage have substantial work experience and earnings capacity, but do not work. This suggests that reforms allowing HIV positive (+) patients to maintain public coverage while returning to work could increase employment and earnings significantly. More speculatively, it suggests that the United States system for financing health care is not well-equipped to deal with epidemics that afflict a population in its prime work years.

Adult↗
PubMed2004

Transitional care issues influencing access to health care: employability and insurability.

Addressing the issues of employability and insurability remains a challenge for young adults with CHD, their parents, and health care professionals who care for this patient group. Because of their chronic condition, these young persons require ongoing access to health care, throughout their adult lives. Because most individuals obtain insurance through their place of employment (unless it is obtained under a spouse's policy), adolescents with CHD should begin to look carefully at career options that are compatible with their interests and their physical abilities. If it is more appropriate, assistance with referral to vocational rehabilitation programs may be given. Finally, guidance should include how to avoid issues of discrimination during a job interview and when working at one's place of employment. Legislation now supports many workers as long as they can carry out the job for which they were hired. With the continuing rise in cost of health care and health insurance coverage, young persons with CHD must understand the high importance of maintaining health care coverage for their chronic health condition, usually through a group plan in their place of employment. Current legislation supports supplemental coverage and portability of coverage when changing jobs, which minimizes or eliminates waiting periods for pre-existing conditions. Suggestions for ongoing health care are included not only for care by a cardiologist but noncardiac care, including a primary care practitioner, dental care, and obstetric-gynecologic care. With the size and life expectancy of this patient group growing each year, the issues of employability and insurability must continually be addressed by health care professionals in conjunction with government policy makers and insurance representatives. As additional long-term survival data become available on the natural history of CHD, it is hoped that insurance requirements will be modified to afford this group the insurance coverage needed to obtain adequate medical and financial security, with facilitated access to appropriate, high quality, and affordable health care.

Adolescent↗
PubMed2003

Extended follow-up of long-term survivors of childhood acute lymphoblastic leukemia.

BACKGROUND: Children who survive acute lymphoblastic leukemia are at risk for leukemia-related or treatment-related complications, which can adversely affect survival and socioeconomic status. We determined the long-term survival and the rates of health insurance coverage, marriage, and employment among patients who had attained at least 10 years of event-free survival. METHODS: A total of 856 eligible patients were treated between 1962 and 1992 in 13 consecutive clinical trials. Survival rates, the cumulative risk of a second neoplasm, and selected indicators of socioeconomic status were analyzed for the entire group and for patients who did or did not receive cranial or craniospinal radiation therapy during initial treatment. RESULTS: Fifty-six patients had major adverse events, including 8 deaths during remission, 4 relapses, and 44 second neoplasms (41 of them radiation-related); most of the second neoplasms were benign or of a low grade of malignant potential. The risk of a second neoplasm was significantly higher in the 597 patients who received radiation therapy (irradiated group) than in the 259 patients who did not receive radiation therapy (nonirradiated group) (P=0.04; estimated cumulative risk [+/-SE] at 20 years, 20.9+/-3.9 percent vs. 0.95+/-0.9 percent). The death rate for the irradiated group slightly exceeded the expected rate in the general U.S. population (standardized mortality ratio, 1.90; 95 percent confidence interval, 1.12 to 3.00), whereas that for the nonirradiated group did not differ from the population norm (standardized mortality ratio, 1.75; 95 percent confidence interval, 0.34 to 5.00). The rates of health insurance coverage, marriage, and employment in the nonirradiated group were similar to the age- and sex-adjusted national averages. Despite having health insurance rates similar to those in the general population, men and women in the irradiated group had higher-than-average unemployment rates (15.1 percent vs. 5.4 percent and 35.4 percent vs. 5.2 percent, respectively), and women in the irradiated group were less likely to be married (35.2 percent vs. 48.8 percent). CONCLUSIONS: Children with acute lymphoblastic leukemia who did not receive radiation therapy and who have attained 10 or more years of event-free survival can expect a normal long-term survival. Irradiation is associated with the development of second neoplasms, a slight excess in mortality, and an increased unemployment rate.

Adolescent↗
PubMedDate not supplied

The relationship between posttraumatic stress disorder and self-reported health problems.

OBJECTIVE: There is increasing awareness that posttraumatic stress disorder (PTSD) influences physical health. The current study used the National Comorbidity Survey (NCS) data to determine if the physical health risk imparted by PTSD was an artifact of a broad range of empirically identified confounding variables. METHODS: Participants (n = 5877) were administered a modified version of the DSM-III-R PTSD module from the Diagnostic Interview Schedule (DIS). The prevalence of 14 classes of physical disorders was assessed along with six groups of variables predictive of negative health outcomes (demographics, perception of health, stress, health-related behaviors, insurance coverage, trauma/psychiatric history, and neuroticism). RESULTS: The PTSD group had a higher frequency of most disorders and scored higher on variables predictive of negative health outcomes. To determine if the health risk imparted by PTSD was an artifact of these confounding variables, a mixed direct-sequential binary logistic regression was computed. After controlling for sex, health perceptions, stress, health-related behaviors, insurance coverage, total trauma exposure, total number of psychiatric diagnoses, and neuroticism, persons with PTSD were more likely to report the presence of a disorder. CONCLUSIONS: Previous scholars have noted that PTSD could affect health outcomes. This study found that after controlling for a wide range of variables predictive of poor health, PTSD was predictive of poor health.

Adult↗
PubMed1990

Acculturation, access to care, and use of preventive services by Hispanics: findings from HHANES 1982-84.

Use of preventive health services (physical, dental, and eye examinations, Pap smear and breast examinations) among Mexican American, Cuban American, and Puerto Rican adults (ages 20-74) was investigated with data from the HHANES. Analyses focused on the relative importance of two predictors of recency of screening: access to services (health insurance coverage, having a routine place for care, type of facility used, having a regular provider, travel time) and acculturation (spoken and written language, ethnic identification). Regression analyses controlling for age, education, and income indicated that utilization of the preventive services was predicted more strongly by access to care than by acculturation. For each Hispanic group, having a routine place for health care, health insurance coverage, and a regular provider were each significantly associated with greater recency of screening. Type of facility used and travel time produced less consistent effects. These results replicate past studies that have demonstrated the important link between institutional access and use of health services. Of the acculturation variables, language but not ethnic identification (which was measured only for the Mexican Americans) predicted use. This latter finding, which has been demonstrated in other studies as well, suggests that the effect of language on screening practices should not be interpreted as a cultural factor, but as an access factor, i.e. use of English favors access to services.

Acculturation↗
PubMedDate not supplied

Choosing from the health care reform menu.

Rising costs and diminished insurance coverage have reduced support for the U.S. health care system among all stakeholders. Proposals for reform have arrayed policymakers along discrete lines, with some favoring incremental reform, others endorsing an expanded role for employers, and still others pushing for a radical conversion to a publicly-financed, publicly-administered program. Each carries enough negatives to make it difficult, if not impossible, to achieve. Rather than waiting for a consensus on one or the other, the U.S. can adopt a strategy that would extend insurance coverage without fueling inflation. All Americans would be guaranteed coverage via a mandate on employers, an expanded public program, and creation of powerful quasi-governmental financial agents who would negotiate and set prices paid to providers.

Cost Control↗
PubMed1994

Sources of health insurance and characteristics of the uninsured. Analysis of the March 1993 Current Population Survey.

This Issue Brief/Special Report examines the extent of health insurance coverage in the United States, the characteristics of the uninsured population by employment status, firm size, industry, income, location, family type, gender and age, race and origin, and education, as well as how the uninsured population has changed over the last several years. Eighty-three percent of nonelderly Americans and 99 percent of elderly Americans (aged 65 and over) were covered by either public or private health insurance in 1992, according to EBRI tabulations of the March 1993 Current Population Survey (CPS). The March 1993 CPS is the most recent data available on the number and characteristics of uninsured Americans. In 1992, 17.$ percent of the nonelderly population--or 38.5 million people--were not covered by private health insurance and did not receive publicly financed health assistance. This compares with 36.3 million in 1991 (16.6 percent), 35.7 million in 1990 (16.5 percent), 34.4 million in 1989 (16.1 percent, and 33.6 million in 1988 (15.9 percent). The most important determinant of health insurance coverage is employment. Nearly two-thirds of the nonelderly (62.5 percent) have employment-based coverage. Workers were much more likely to be covered by employment-based health plans than nonworkers (71 percent, compared with 40 percent). A primary reason for the increase in the number of uninsured between 1991 and 1992 is a decline in employment-based coverage among individuals (and their families) working for small firms. Forty-two percent of the additional 2.2 million individuals without coverage between 1991 and 1992 were in families in which the family head worked for an employer with fewer than 25 employees. The number of children who were uninsured in 1992 was 9.8 million, or 14.8 percent of all children. This compares with 9.5 million and 14.7 percent in 1991. The increase in the number and proportion of uninsured children was partially offset by an increase in the proportion of children with Medicaid. In 12 states and the District of Columbia, more than 20 percent of the population was uninsured in 1992 (table 3). These states and their uninsured rates were Nevada (26.6 percent), Oklahoma (25.8 percent), Louisiana (25.7 percent), Texas (25.7 percent), the District of Columbia (25.5 percent), Florida (24.2 percent), Arkansas (23.5 percent), California (22.2 percent), South Carolina (20.8 percent) and Alabama (20.1 percent).

Adolescent↗
PubMed2003

Diagnosis and treatment of depression in the elderly medicare population: predictors, disparities, and trends.

OBJECTIVES: To develop nationally representative estimates of rates of diagnosis of depression; to determine rates and type of treatment received by those diagnosed with depression; and to ascertain socioeconomic differences and trends in treatment rates of depression, including the effect of supplemental insurance coverage, for elderly Medicare fee-for-service beneficiaries. DESIGN: Analysis of merged interview and Medicare claims data for multiple years from merged Medicare claims and interview data from the Medicare Current Beneficiary Survey (MCBS), a nationally representative survey of Medicare participants. SETTING: Community dwellers. PARTICIPANTS: Twenty thousand nine hundred sixty-six community-dwelling respondents aged 65 and older in the MCBS cost and use files for 1992 through 1998. MEASUREMENTS: Diagnoses recorded in Medicare claims were used to identify individuals who received a diagnosis of depression from a healthcare provider; pharmacy and claims data were used to identify receipt of antidepressants and psychotherapy by those diagnosed. RESULTS: The rate of depression diagnosis more than doubled, reaching 5.8% in 1998. Overall, about two-thirds of those diagnosed received treatment in each year; but those aged 75 and older, those of "Hispanic or other" ethnicity, and those without additional coverage to supplement Medicare were significantly less likely to receive treatment, controlling for other characteristics. If treated, members of these disadvantaged subgroups were less likely to receive psychotherapy. CONCLUSION: Although depression has been thought until recent years to be underrecognized in the elderly, rates of diagnosis increased dramatically in the 1990s, with concomitant increases in treatment. Nevertheless, significant disparities by age, ethnicity, and supplemental insurance coverage persist in treatment of those diagnosed. Because depression is a major source of potentially treatable morbidity in older people, increased efforts are needed to ensure access to appropriate treatment across all subgroups of older people and to remove economic barriers to treatment.

Activities of Daily Living↗
PubMed2000

Differences in physician utilization between Aboriginal and non-Aboriginal children.

OBJECTIVE: In the present study, we examined the factors affecting Aboriginal children's visits to a medical practitioner and compared them with non-Aboriginal children. METHODS: We selected five Aboriginal communities and four neighbouring non-Aboriginal communities, and conducted a door-to-door survey, covering all children born after 1983. Of an initial sample of 1013 children, 896 (response rate 89.92% for non-Aboriginal children and 85.87% for Aboriginal children) completed the questionnaire for analysis. RESULTS: In all, 896 children of non-mixed lineage with an age range of 0-12 years were collected into the study, including 316 Aborigines and 580 non-Aborigines. A higher percentage of non-Aboriginal children had more national health insurance coverage than Aboriginal children. The ratio of parents using the services of an out of community medical practitioner when their children were sick was higher for Aboriginal parents than for non-Aborigines. Medical injection frequency was higher in Aboriginal children. Linear regression was used to examine the factors affecting the frequency of physician utilization in the preceding month. CONCLUSION: A lower national health insurance coverage rate, and a higher rate of intramuscular injections for Aboriginal children plus difficulties in access to medical resources due to travel time and travel distance are still major problems for the Aborigines.

Child↗
PubMed1996

Determinants of emergency department use: are race and ethnicity important?

STUDY OBJECTIVE: To determine whether race/ethnicity is an important determinant of emergency department use. METHODS: We conducted a cross-sectional survey in a public ED to determine self-reported ED visits over the preceding 3 months. The study group comprised consecutive ambulatory patients (N = 1,049) with nonemergency medical problems. RESULTS: Blacks, whites, and Hispanics were equally likely to report one or more visits to an ED in the 3 months before study enrollment. Blacks were the most likely to report two or more ED visits in the preceding 3 months (19.0%), followed by whites (13.5%) and Hispanics (11.4%) (P = .01; unadjusted odds ratio, 1.82 for blacks versus Hispanics). In multivariate analysis, older age (P < .001), health insurance coverage (P < .001), regular source of care (P < .001), and difficulty obtaining transportation to a physician's office (P = .011) were positively associated with two or more previous ED visits. After adjustment for these variables, race/ethnicity was not significantly associated with ED use (P = .23; adjusted odds ratio for blacks versus Hispanics, 1.48 [95% confidence interval, .95 to 2.30]). CONCLUSION: Race/ethnicity was not an important determinant of ED use after adjustment for age, health insurance coverage, regular source of care, and barriers to health care. Population-based studies of ED use should be conducted to further evaluate whether racial/ethnic differences in ED use exist that are not explained by differences in demographics, health, socioeconomic status, access to care, or other determinants of ED use.

Adult↗
PubMed2001

Differential impact of recent Medicaid expansions by race and ethnicity.

OBJECTIVE: Between 1989 and 1995, expansions in Medicaid eligibility provided publicly financed health insurance to an additional 7 million poor and near-poor children. It is not known whether these expansions affected children's insurance coverage, use of health care services, or health status differently, depending on their race/ethnicity. The objective of this study was to examine, by race/ethnicity, the impact of the recent Medicaid expansions on levels of uninsured individuals, health care service utilization, and health status of the targeted groups of children. METHODS: Using a stratified set of longitudinal data from the National Health Interview Surveys of 1989 and 1995, we compared changes in measures of health insurance coverage, health services utilization, and health status for poor white, black, and Hispanic 1- to 12-year-old children. To control for underlying trends over time, we subtracted 1989 to 1995 changes in these outcomes among nonpoor children from changes among the poor children for each race/ethnicity group. Measures of coverage included uninsured rates and Medicaid rates. Utilization measures included annual probability of visiting a doctor, annual number of doctor visits, and annual probability of hospitalization. Health status measures included self-reported health status and number of restricted-activity days in the 2 weeks before the interview. Differences in means were analyzed with the use of Student's t tests accounting for the clustering sample design of the National Health Interview Surveys. RESULTS: Among poor children between 1989 and 1995, uninsured rates declined by 4 percentage points for whites, 11 percentage points for blacks, and 19 percentage points for Hispanics. Medicaid rates for these groups increased by 16 percentage points, 22 percentage points, and 23 percentage points, respectively. With respect to utilization, the annual probability of seeing a physician increased 7 percentage points among poor blacks and Hispanics but only 1 percentage point among poor whites (not significant) for children in good, fair, or poor health. Among those in excellent or very good health, the respective increases were 1 percentage point for poor whites (not significant), 7 percentage points for poor blacks, and 3 percentage points for poor Hispanics (not significant). Significant increases in numbers of doctor visits per year were recorded only for poor Hispanics who were in excellent or very good health, whereas significant decreases in hospitalizations were recorded for Hispanics who were in good fair or poor health. Measures of health status remained unchanged for poor children over time. The recorded decreases in uninsured rates and increases in Medicaid coverage remained robust to adjustments for underlying trends for all 3 race/ethnicity groups. With respect to adjusted measures of utilization and health status, the only significant differences found were among poor blacks who were in good, fair, or poor health and who registered increases in the likelihood of hospitalization and in poor Hispanics who were in excellent or very good health and who registered decreases in the numbers of restricted-activity days. CONCLUSIONS: Recent expansions in the Medicaid program from 1989 to 1995 produced greater reductions in uninsured rates among poor minority children than among poor white children. Regardless of race/ethnicity, poor children did not seem to experience significant changes during the period of the expansions in either their level of health service utilization or their health status.Medicaid, health insurance, health status, health services.

Black or African American↗
PubMed2006

Dental service use and its correlates in a dentate population: an analysis of the Saskatchewan population health and dynamics survey, 1999-2000.

OBJECTIVES: To document the frequency of self-reported use of dental services within a 2-year period by a sample of dentate Saskatchewan residents aged 18 years and older; explore the correlates associated with dental service use for men and women separately; and examine the age, gender and income distribution of dental insurance coverage. METHODS: The 1999-2000 Saskatchewan Population Health and Dynamics Survey provided a representative sample of 5,003 dentate respondents (mean age 45.5 years; 52.3% women), 18 years and older, randomly selected and interviewed by telephone. RESULTS: Of those interviewed, 77% of the women and 67% of the men reported a dental visit within the previous 2 years. For women, logistic regression analysis indicated that when all other factors were held constant, the odds of dental service use within the last 2 years were higher among those who were aged 18-19 years, had post-secondary education or technical certification, were in the highest household income adequacy category, held dental insurance and engaged in such preventive behaviours as regular general checkups, eye checkups, skin self-examination and not smoking daily. For men, the odds of dental service use within the last 2 years were greater if they had education at or beyond the secondary level, were students, were in the upper or highest income adequacy levels, held dental insurance and engaged in preventive health behaviours such as general checkups, eye checkups and not smoking daily. Dental insurance coverage was strongly associated with household income adequacy and peaked among men and women aged 30-49 years. CONCLUSIONS: This study indicates that the roles of gender, income, education, age, health-related behaviours and resources such as dental insurance should be considered in future public oral health strategies. We propose a conceptual model to aid in understanding the social structural and individual pathways to oral health.

Adolescent↗
PubMed2005

Funding, ethics, and assistive technology: should medical necessity be the criterion by which wheeled mobility equipment is justified?

The article will explore the use of the term medical necessity as it relates to wheeled mobility. Health insurance will cover a wheelchair if it is determined that it is medically necessary for a particular client. There are many different types of health insurance, and no universal definition of medical necessity. This presents a problem for clients and for individuals who are making wheelchair recommendations for clients. Case studies describe how equipment is currently recommended based on the limitations of the client's insurance coverage. As more equipment becomes available to improve the quality of life for people with disabilities, it will become harder for therapists recommending equipment to determine the limits of medical necessity.

Activities of Daily Living↗