Veteran Access to Quality Wheelchairs: Do Disparities Exist?

Principal Investigator: Diane Collins, PhD, OTR/L

Co-Investigators: Rory A. Cooper, PhD; Emily Teodorski, BS

2006

Not only providing a means to complete daily activities, wheelchairs use significantly influences community participation and quality of life. In turn, wheelchair quality significantly impacts mobility, function, and the health of the individuals who rely on them. Studies have confirmed that higher quality, more costly wheelchairs correspond with higher K-Codes (classification codes used by the Centers for Medicaid/Medicare Services). Lower quality wheelchairs are heavier, fit the user more poorly, and their frames fatigue more quickly. Consequently, people who use lower quality wheelchairs are at greater risk of developing secondary upper-extremity injuries, which diminishes mobility and increases dependency and healthcare costs. Thus, the initial savings from purchasing less expensive wheelchairs are negated by greater personal and economic costs that result from extended use.

In the U.S., an estimated 2.2 million people currently use wheelchairs. Expenditures by health insurers provide evidence to these numbers. For example, the VHA provided approximately 40,000 wheelchairs at a cost of over twenty million dollars in 2000. In 2003, CMS estimates the agency spent $7.7 billion on durable medical equipment, which included wheelchairs; this expense accounted for 1.3% of U.S. public health expenditures. Experts predict that the number of people who need wheelchairs will increase by 22 percent over the next ten years

Access to healthcare services is not equal for individuals in who are elderly, those in minority groups, the socioeconomically disadvantaged, and women in the U.S. Research documenting these disparities is abundant. However, the results of research studies investigating healthcare service disparity in the Veterans Administration Healthcare System (VHS) are mixed. While it is unclear whether disparities exist in the VHS, an important trend is known - veterans from minority groups use VA healthcare services more often than white veterans. Thus, disparity in the VHS should be investigated and if found, addressed. We propose a cross-sectional study of 1,200 people who use wheelchairs to investigate disparity in access to higher quality wheelchairs in veteran populations compared to civilian populations.

The Paralyzed Veterans of America (PVA) Organization has a membership of 21,000+ veterans who have paralysis typically from spinal cord injuries/dysfunction. They have agreed to help the investigators recruit 486 subjects for this study. To date, the PVA has sent out 1500 brochures to randomly selected members, and the investigators at HERL have received 208 responses, of whom 37 people choose not to participate in the study. The remaining 171 potential participants have been mailed study packets by investigators, with 115 surveys returned to date. Data will be analyzed after a second mailing of brochures is completed.