1. RTC Managed Care & Disability 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. RTC Managed Care & Disability 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. RTC Managed Care & Disability 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. RTC Managed Care & Disability 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. RTC Managed Care & Disability 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. RTC Managed Care & Disability Primary Variables, cont’d Access to services –In the last 3 months….. q I did not need to see my primary care or personal doctor. q I saw my primary care or personal doctor every time I needed to. q I did not see my primary care or personal doctor every time I needed to.

7. RTC Managed Care & Disability 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. RTC Managed Care & Disability 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. RTC Managed Care & Disability 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. RTC Managed Care & Disability Bivariate Results: Need for Healthcare Services

11. RTC Managed Care & Disability 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. RTC Managed Care & Disability 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. Multivariate Results: Health Plan and Payer Variables

13. RTC Managed Care & Disability 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. RTC Managed Care & Disability Multivariate Results: Sociodemographic Variables 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. RTC Managed Care & Disability Respondents covered by FFS plans appear more likely than those covered my managed care plans to see their specialists every time needed. Conclusions: Access to Specialists

16. RTC Managed Care & Disability 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. RTC Managed Care & Disability 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. Conclusions: Access Inequities

18. RTC Managed Care & Disability 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. Conclusions: Implications for Reform

19. RTC Managed Care & Disability Next Steps: Combine 3 waves of health care experience data Independent Variable = Access Dependent Variable = Changes in health and functional status AccessChange in Health Status ?