Rise in U.S. disability health care spending, but preventive care may reduce expenditure

RTI InternationalDec 10 2009

Just over one-quarter of U.S. adult health care spending was associated with disability in 2006, according to a new study by researchers at RTI International and the U.S. Centers for Disease Control & Prevention.

The study, published in the January-February issue of Public Health Reports, found that disability-associated health care spending for U.S. adults totaled $397.8 billion in 2006, which was almost 27 percent of U.S. adult health care spending. New York had the highest disability-associated health care spending at $40.1 billion and Wyoming had the lowest, with $598 million.

Eighteen percent of all adults reported having a disability, defined as having any limitation resulting from a physical, mental or emotional problem, according to the study. The disability-associated health care costs included the treatment costs for conditions such as traumatic brain injuries, strokes, and vision impairment and some treatment costs for chronic conditions such as diabetes and arthritis.

"Most people think of disability as affecting only seniors, but many younger adults also have a disability," said Wayne Anderson, Ph.D., a senior health policy analyst at RTI, and the paper's lead author. "Disability often complicates obtaining health care, including for people with chronic conditions such as heart disease and diabetes. When looking for ways to improve health and control costs, the role of disability in care management should be addressed."

Wayne Anderson discusses adult health care costs and disabilityAccording to the research, the costs of health care for people with disabilities are borne largely by the public sector, particularly Medicaid, where 68 percent of the program's spending was associated with disability. Approximately 38 percent of all Medicare spending was associated with disability, as well as 12 percent of health care costs for those with either private insurance or who were uninsured.

The findings suggest that disability-associated health care spending may be reduced by encouraging preventive care service use such as smoking cessation and mammograms, by health improvement interventions such as nutritional improvement programs and, most importantly, by improving access to acute medical care for people with disabilities. Health promotion and disease management programs that help people with disabilities improve diet and physical activity and manage chronic conditions can help maintain functional independence and may help reduce health care spending by decreasing hospitalization and premature nursing home entry.

"We're finding that people with disabilities aren't getting the same level of preventive care every day as people without disabilities," says Dr. Brian Armour, lead health scientist at CDC's National Center on Birth Defects and Developmental Disabilities. "It's important to realize that people with disabilities can be healthy if barriers to care are reduced."

The study found that the costs per person with a disability were highest in the Northeast, several southeastern states, Alaska and Hawaii, where the costs exceeded $13,000 per person per year in most of those states. The lowest costs per person with a disability, less than $10,000 per person per year, were found in the West or Mountain regions (see map).

The study used data from the 2002-2003 Medical Expenditure Panel Survey and state-level data from the Behavioral Risk Factor Surveillance System.