Individuals with chronic and/or disabling conditions: Determinants of utilization of physical rehabilitation services

A major U.S. health policy challenge is curbing the increasing costs of healthcare while ensuring access to quality services. People with chronic conditions and/or disabilities represent a unique vulnerable population that has higher rates of utilization of healthcare services than other groups. Disability is associated with individuals withdrawing from society and not participating in the economic workforce. These individuals are not only at risk for recurrent medical conditions but can have activity limitations that often have a negative effect on their ability to interact with society. Access to and utilization of timely healthcare services are necessary for the health of people with chronic conditions and/or disabilities. One specific service, physical rehabilitation, allows for people to receive interventions that influence the performance of functional activities, thus allowing them to continue with or return to being productive members of society. This dissertation contributes to the emerging disability and health policy literature through presenting the results of an analysis of data from the 1999 component of a three-year national survey of individuals with cerebral palsy (CP), multiple sclerosis (MS), and spinal cord injury (SCI). Specifically, the following questions are answered: is self-reported need a valid distinction between two groups in a population of individuals with chronic and/or disabling conditions? and what variables influence whether this population received or didn't receive self-reported needed physical rehabilitation services? Basic descriptive statistics, contingency tables, and logistic regression models were used. Results indicated that of those respondents who needed rehabilitation services, fifty-three percent did not receive them. Respondents who had Medicaid were more likely than those with Medicare or private insurance to receive services. Respondents having a lower household income and poorer health were associated with being less likely to receive services. Policy implications regarding the inequity among health insurance funding sources and reimbursement for physical rehabilitation services are discussed.