Research PaperPrevalence and reasons for delaying and foregoing necessary care by the presence and type of disability among working-age adults
Section snippets
Methods
The Medical Expenditure Panel Survey (MEPS) is a nationally-representative survey of US community-dwelling people of all ages. It uses a complex sampling methodology to provide information on health service use and costs, health conditions, and insurance coverage.29 We pooled data from 2004 to 2010 to create an unweighted sample of 236,240 people. Combining this number of years was necessary to achieve a sufficiently large sample to examine multiple characteristics across disability subgroups,
Statistical analysis
Analyses, conducted using Stata MP/13 (College Station, TX), accounted for the complex sampling design of MEPS. To reflect annualized national estimates, all data were weighted using the person weight divided by 7 (number of years of data pooled), per AHRQ recommendation in MEPS documentation.29 Given that a respondent has a different weight assigned for each of the two years they are on the survey panel, every person is counted separately for each year that they are included. This has no
Results
Nearly 13% of working-age adults reported a disability (Table 1). Overall, 82% (95% CI: 17.0–18.3) of working-age adults were insured; people with disabilities, except those with visual impairments, more frequently reported having insurance than people without disabilities.
Discussion
For all working-age people, the strongest association for receiving timely necessary care was with the presence of health insurance. This is not surprising given the acknowledged relationship between these factors.31, 32, 33 Undoubtedly, ensuring greater health insurance coverage is warranted and likely to result in improvements in timely receipt of care; however, it is concerning that among those who were insured, a substantial proportion reported having to delay/forgo necessary care. Over 10%
Conclusion
Although insurance status was the strongest predictor of unmet needs for care, many people with insurance delayed/forwent necessary care. Even among the insured, all disability subgroups had a significantly greater likelihood of having to delay/forgo care than those without disabilities. Differences existed between the disability subgroups, reinforcing the concept that risk for unmet needs is multifaceted. Cost was cited most frequently as the reason for unmet needs, likely due in large part to
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This work was funded under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research, award #H133A100031.
Portions of this work were submitted at the 2015 American Public Health Association and Academy Health annual meetings.