A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
According to the Centers for Disease Control and Prevention, adults with disabilities have less access to adequate health care, including preventative services. Regular access to preventative services can reduce the risk of being hospitalized for preventable conditions such as complications due to diabetes or heart failure. Previous studies have shown that people with commercial insurance are more likely to use preventative services than those with Medicare and Medicaid. However, not much is known about how different types of insurance affect the use of preventative services that could potentially lower the risk of preventable hospitalization (PPH) among people with disabilities.
In a recent NIDILRR-funded study, researchers looked at the relationship between the use of preventative services and PPH risk based on insurance types among adults with cerebral palsy or spina bifida (CP/SB), traumatic spinal cord injury (TSCI), and multiple sclerosis (MS). Specifically, the researchers wanted to compare the usage of preventative services and PPH risk between the following groups: participants with commercial insurance and those with traditional Medicare; participants with traditional Medicare and those with Medicare Advantage, a commercial insurance for Medicare for adults 65+ years old which covers preventative services that traditional Medicare does not; and participants eligible for both Medicare and Medicaid (dual eligible as defined under traditional Medicare) and those who were non-dual eligible.
Researchers at the Rehabilitation Research and Training Center (RRTC) on Promoting Healthy Aging for People with Long-Term Physical Disabilities looked at claims data from Medicare and the Clinformatics DataMart, a large insurance claims database. The data used for this study came from more than 56,000 people with CP/SB, TSCI, or MS, aged 18 and older, who were enrolled between 2008-2016. Researchers examined data for the use of preventative services (annual wellness visit, bone mineral density screening, cholesterol screening, diabetes screening, and physical and occupational therapy), and any inpatient claims for PPH such as heart failure, pneumonia, and complications due to diabetes, among others.
Overall, a higher percent of adults with CP/SB and with MS have traditional Medicare than commercial insurance overall. Researchers found significant differences in the use of preventative care services and PPH risk among adults with disabilities with different insurance types:
- Across all three disabilities, participants with commercial insurance had higher usage of wellness visits, bone mineral density screening, cholesterol screening, and physical and occupational therapy than those with traditional Medicare.
- Across all three disabilities, PPH risk was 1.50-2.34 times higher among those with traditional Medicare compared to their counterparts with commercial insurance.
- For participants 65 or older, PPH risk was 1.15-1.61 x higher for those with traditional Medicare than those with Medicare Advantage.
- Dual-eligible adults with a disability have lower use of preventive care and higher PPH risk (1.47-1.81 times higher) than non-dual eligible participants.
- Across all three disabilities, annual wellness visits reduced the PPH risk, regardless of insurance type.
The results of this study corroborate previous studies showing that adults with traditional Medicare have lower rates of preventative care and higher risk of PPH compared to those with commercial insurance. The authors noted that commercial insurance may be more efficient and effective for accessing preventative care, with wider networks of providers, high quality primary care clinics, and more options for labs and testing facilities. The authors suggested that dual-eligible participants may have higher risk for PPH and face challenges in accessing preventative services because many physicians do not accept these patients due to Medicaid’s low reimbursement rates.
While annual wellness visits can help reduce the risk of PPH, the barriers of cost for commercial insurance and access to providers who accept Medicare or Medicaid may make it more challenging for adults with disabilities to manage complex medical conditions and avoid PPH. This study’s findings highlight the importance of access to better insurance coverage for people with disabilities in order to find better quality clinicians and coordinated preventative care.
To learn more:
The authors of this study discussed their research in a webinar The Effect of Public and Private Health Insurance on the Use of Preventive Services for People with Disabilities.
Healthcare.gov and Medicare.gov offer information about private and public health insurance programs, including Medicaid and Medicare, and how to access benefits for preventative care.
To learn more about this study:
Mahmoudi, E., Lin, P., Rubenstein, D., Guetterman, T., Leggett, A., Possin, K.L, and Kamdar, N. (2024) Use of preventative service and potentially preventable hospitalization among adults with disability: Longitudinal analysis of Traditional Medicare and commercial insurance. Preventive Medicine Reports, 40. This article is available from the NARIC collection under Accession Number J93903.