title: The effects of insurance benefits coverage on functional and psychosocial outcomes after spinal cord injury.
abstract: This retrospective study examined the effects of type of payor (ie, catastrophic, Medicaid, and private) and extent of benefits and independent living (IL) resources received on functional and psychosocial outcomes after spinal cord injury (SCI). One hundred seventy SCI persons with dates of injury from 1985 to 1990 and who were on average 4 years after their initial discharge from rehabilitation participated in the study. Benefits and resources received from discharge to 2 years post-injury in housing, transportation, personal care assistance (PCA), and equipment were assessed. Outcome variables included measures of psychological distress, self-esteem, and participation in physical and work/school activities. Extent of benefits received after SCI was found to be both a function of source of payor and of subject's neurological classification. While an effect of total benefits received could not be detected on SCI subjects post-discharge physical activity, and benefits paid by self only were associated with physical activity. Transportation benefits received and type of payor were positively associated with work/school outcomes. Younger subjects, sponsored by private payors, and with incomplete injuries were more likely to be working or going to school after SCI. Benefits and payor were also associated with psychological distress. Privately sponsored subjects were less distressed, whereas those sponsored by Medicaid were most distressed. Extent of benefits received was found to be inversely associated with distress and self-esteem. Persons with lower self-esteem received more postdischarge benefits, whereas those who paid for their own benefits and those who received communication equipment benefits paid by insurance, reported higher self-esteem. Implications for possible policy changes based on these results are discussed.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center, Ann Arbor 48109-0050.
authors.forename: D G
authors.initials: DG
authors.lastname: Tate
authors.forename: W
authors.initials: W
authors.lastname: Stiers
authors.forename: J
authors.initials: J
authors.lastname: Daugherty
authors.forename: M
authors.initials: M
authors.lastname: Forchheimer
authors.forename: E
authors.initials: E
authors.lastname: Cohen
authors.forename: N
authors.initials: N
authors.lastname: Hansen
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000704:Analysis of Variance; D004651:Employment; D005260:Female; D006798:Housing; D006801:Humans; D007349:Insurance, Health, Reimbursement; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D008824:Michigan; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011593:Psychology, Social; D012047:Rehabilitation Centers / Q000191:economics*; D012189:Retrospective Studies; D012574:Schools; D012649:Self Concept; D012656:Self-Help Devices; D013119:Spinal Cord Injuries / Q000191:economics* / Q000503:physiopathology* / Q000523:psychology / Q000534:rehabilitation; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology; D014187:Transportation of Patients; D014481:United States