Access to Healthcare Services Among People With Disabilities in Managed Care and Fee-for-Service Health Plans

1. Access to Healthcare Services Among People With Disabilities in Managed Care and Fee-for-Service Health Plans Gerben DeJong Phillip Beatty Melinda Neri NRH Center for Health & Disability Research, Washington, DC Kristofer Hagglund Department of Physical Medicine & Rehabilitation, University of Missouri, Columbia

2. National Survey of People With Cerebral Palsy, Multiple Sclerosis, Spinal Cord Injury, or Arthritis • Survey Collaborators: • RRTC on Managed Care and Disability • Missouri Arthritis RRTC • Funding Source: • National Institute on Disability and Rehabilitation Research

3. National Longitudinal Survey • Analyzed Round 1 data for a sample of 800 adults (18+) with: • Cerebral Palsy (n=110; 14%) • Multiple Sclerosis (n=164; 20%) • Spinal Cord Injury (n=169; 21%) • Arthritis (357; 45%) • Sample recruited nationally through: • National membership organizations , IL centers, libraries, and disability related e-mail listservs

4. Study Goal • Goal: To determine whether health plan type is associated with access to health services among people with cerebral palsy (CP), multiple sclerosis (MS), spinal cord injury (SCI) or arthritis.

5. Primary Variables • Health Plan type: • Managed Care (n=428; 53%) • Fee-For-Service (n=372; 47%) • Access to Healthcare Services • Primary care doctor • Specialist(s) • Physical Rehabilitation • Assistive Equipment • Prescription Medications ?

6. Primary Variables, cont’d • Access to services • In the last 3 months….. • I did not need to see my primary care or personal doctor. • I saw my primary care or personal doctor every time I needed to. • I did not see my primary care or personal doctor every time I needed to.

7. Control Variables • Disability Type • CP; MS; SCI; Arthritis • Health Status • Excellent/Very Good; Good; Fair/Poor • Disability Severity • 0 ADLs; 1-3 ADLs; 4-6 ADLs • Gender • Female, Male • Payer • Private; Medicare; Medicaid • Income Level • LT $20,000; $20,001-$40,000; $40,001-$60,000; $60,001+ • Region • Northeast; South, Midwest, West

8. Analyses • Bivariate Analyses: • Crosstabulation of control variables, by health plan type • Crosstabulation of access variables, by health plan type and control variables. • Logistic Regression Analyses: • Among those reporting a need for each service, regression of access measure on health plan type, and control variables.

9. Sample Characteristics, by Healthcare Coverage Type • Respondents covered by managed care plans, relative to those covered by fee-for-service plans, were: • Younger • Less likely to have ADL limitations • More likely to be covered by private insurance • More likely to be in a higher income category • More likely to live in the West

10. Bivariate Results: Need for Healthcare Services

11. Bivariate Results: Percent in Receipt of Service, “every time it was needed” (n=570) (n=569) (n=290) (n=340) (n=757) * p < .05

12. Multivariate Results:Health Plan and Payer Variables • Health Plan Type: People enrolled in managed care plans were less likely to see a specialist every time needed. • Health plan type was not associated with access to primary care providers, rehabilitation, equipment, or prescriptions. • Payer type: Access to services did not differ across payer types.

13. Multivariate Results:Health Status and Disability Variables • Health Status: Significantly associated with every health service area except for prescriptions. People in poorer health were significantly less likely to receive services every time needed. • Disability Severity: People with 1-3 ADL limitations were significantly less likely than those with 0 limitations to receive rehabilitation every time needed. • Disability Type: People with arthritis were generally the most likely to receive services every time they were needed. People with CP were generally the least likely to receive needed services.

14. Multivariate Results:SociodemographicVariables • Income Level: People with household incomes lower than $20,000 were significantly less likely to report regular access to specialists, rehabilitative services, equipment, and medications. • Age: Increasing age was associated with a decreasing likelihood of receiving medications every time needed. • Region: Region was unrelated to health care access.

15. Conclusions:Access to Specialists • Respondents covered by FFS plans appear more likely than those covered my managed care plans to see their specialists every time needed.

16. Conclusions:Rehabilitation and Equipment • A substantial proportion of people with CP, MS, SCI, or Arthritis are not receiving the health care services they need. • Nearly half did not receive medical rehabilitation services every time needed, and almost a third didn’t receive equipment.

17. Conclusions:Access Inequities • Health status and income level were the strongest, and most consistent predictors of access. • Those in the poorest health, and those with the fewest resources were the least likely to receive needed services across the spectrum, regardless of health plan type.

18. Conclusions:Implications for Reform • Our findings suggest that broad-based health care reforms are necessary. • A sizable percentage of people with disabilities and chronic conditions are still covered traditionally in FFS plans. • Reform policies aimed solely at managed care organizations may fall short of achieving greater access for people with disabilities or chronic conditions.

19. Next Steps: • Combine 3 waves of health care experience data • Independent Variable = Access • Dependent Variable = Changes in health and functional status Access Change in Health Status ?