Research Paper
Prevalence and reasons for delaying and foregoing necessary care by the presence and type of disability among working-age adults

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Abstract

Background

While it is commonly accepted that disparities in unmet need for care vary by age, race/ethnicity, income, education, and access to care, literature documenting unmet needs experienced by adults with different types of disabilities is developing.

Objective

The main objective was to determine whether subgroups of people with disabilities are more likely than people without disabilities to delay/forgo necessary care, in general and among the insured.

Methods

We used pooled Medical Expenditure Panel Survey data (2004–2010) to examine delaying or forgoing medical, dental, and pharmacy care among five disability subgroups (physical, cognitive, visual, hearing, multiple) and the non-disabled population. Logistic regression was conducted to examine delayed/forgone care, controlling for sociodemographic, health, and health care factors.

Results

Over 13% of all working-age adults delayed/forwent necessary care; lack of insurance was the strongest predictor of unmet needs. Among the insured, disability subgroups were greater than two times more likely to report delayed/forgone care than adults without disabilities. Insured working-age adults with multiple chronic conditions and those with ADL/IADL assistance needs had higher odds of delayed or forgone care than their peers without these characteristics. Reasons related to affordability were most often listed as leading to unmet needs, regardless of disability.

Conclusion

Although insurance status most strongly predicted unmet needs for care, many people with insurance delayed/forewent necessary care. Even among the insured, all disability subgroups had significantly greater likelihood of having to delay/forgo care than those without disabilities. Differences also existed between the disability subgroups. Cost was most frequently cited reason for unmet needs.

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.

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