Health Care Expenditures Among Working-Age Adults With Physical Disabilities: Variations by Disability Spans

Health spending is more than twice as much for people with persistent disabilities than for those whose disabilities are temporary, according to a recent study in Disability and Health Journal. [1] For the persistent disability group, median health spending was $4,234, and out-of-pocket (OOP) spending was $591. For those whose disability was temporary, those amounts were $1,612 and $388, respectively. Financial burden ratios — the percentage of family income dedicated to OOP spending — were 1.59 for the persistent disability group versus 0.71 for the temporary disability group.

Several studies have examined health care costs for the elderly and children with disabilities, but data for working-age adults with disabilities are sparse.

For working-age adults, the costs of living with disabilities are substantial. In 2008, the U.S. government spent $357 billion on assistance to working-age adults with disabilities, approximately 12% of all federal expenditures. Health care and income maintenance accounted for more than 47% of federal spending for working-age people with disabilities.

Results, discussion and conclusions

The researchers used data from Medical Expenditure Panel Survey panel 12 (2007–2008). The study classified respondents into three groups: temporary disability, persistent disability and no disability. Medians of average annual expenditures, OOP expenditures, and financial ratios were weighted.

While disability rates increase with age, adults aged 18–64 make up more than 52% of the total disabled population. Among working-age adults surveyed in 2007–2008, 15% reported a disability in both years of the survey period (persistent disability) and approximately 7% reported a disability in the first year (temporary disability).

Those in the persistent disability group paid roughly 15% of their total health care costs out-of-pocket, while both the temporary disability group and the no disability group paid 22%. People who have disabling conditions that persist have better financial protection against OOP health care expenses than other groups, but they still face greater financial burdens because of their higher OOP expenditures and socioeconomic disadvantages. People with disabilities generally experience higher rates of poverty and unemployment, lower educational attainment, and are less likely to have adequate health insurance coverage.

Across disability types, temporarily disabled adults were more similar to the nondisabled population than to permanently disabled adults in ways that affect the financial burden of care. For example, rates of private insurance coverage were 73% for temporarily disabled adults and 74% for nondisabled respondents versus 56.4% among the persistently disabled. Similarly, the percentages of temporarily disabled and nondisabled adults who were poor or near poor were 17.5% and 11.8%, respectively, while the rate for adults whose disabilities persist was 26.7%.

Median total expenditures among persistently disabled adults were almost six times higher than among the nondisabled: $4,234 compared with $748. Across all adults, median costs were highest for outpatient services, followed by prescription drugs. Among service users, the highest median expenditures were for inpatient care, followed by outpatient services. For outpatient care and prescription drugs, median expenditures were significantly higher for persistently disabled adults than for either nondisabled or temporarily disabled adults.

The adjusted median financial burden ratio among persistently disabled adults was higher than the ratio for their counterparts without disabilities. Adults with persistent disabilities seemed to be least protected from prescription drug costs, with persons who used medications spending 0.6% of total family income (median) for these products.

According to the authors of the study, these findings suggest that caps on out-of-pocket spending could benefit permanently disabled individuals. Expenditure caps could be targeted to those with persistent disabilities who are most economically disadvantaged and have multiple chronic health conditions.