Estimates of state-level health-care expenditures associated with disability.
OBJECTIVE
We estimated state-level disability-associated health-care expenditures (DAHE) for the U.S. adult population.


METHODS
We used a two-part model to estimate DAHE for the noninstitutionalized U.S. civilian adult population using data from the 2002-2003 Medical Expenditure Panel Survey and state-level data from the Behavioral Risk Factor Surveillance System. Administrative data for people in institutions were added to generate estimates for the total adult noninstitutionalized population. Individual-level data on total health-care expenditures along with demographic, socioeconomic, geographic, and payer characteristics were used in the models.


RESULTS
The DAHE for all U.S. adults totaled $397.8 billion in 2006, with state expenditures ranging from $598 million in Wyoming to $40.1 billion in New York. Of the national total, the DAHE were $118.9 billion for the Medicare population, $161.1 billion for Medicaid recipients, and $117.8 billion for the privately insured and uninsured populations. For the total U.S. adult population, 26.7% of health-care expenditures were associated with disability, with proportions by state ranging from 16.9% in Hawaii to 32.8% in New York. This proportion varied greatly by payer, with 38.1% for Medicare expenditures, 68.7% for Medicaid expenditures, and 12.5% for nonpublic health-care expenditures associated with disability.


CONCLUSIONS
DAHE vary greatly by state and are borne largely by the public sector, and particularly by Medicaid. Policy makers need to consider initiatives that will help reduce the prevalence of disabilities and disability-related health disparities, as well as improve the lives of people with disabilities.
Anderson
Wayne L
WL
RTI International, PO Box 12194, Research Triangle Park, NC 27709-2194, USA. wlanderson@rti.org
Armour
Brian S
BS
Finkelstein
Eric A
EA
Wiener
Joshua M
JM
D000328:Adult; D017281:Cost of Illness; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000191:economics* / Q000706:statistics & numerical data; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D018803:Models, Economic; D014481:United States
Inquiry. 2007 Spring;44(1):69-87
17583262
Obes Res. 2004 Jan;12(1):18-24
14742838
Public Health Rep. 1998 Sep-Oct;113(5):447-58
9769770
Gerontologist. 2007 Dec;47(6):838-44
18192637
Health Care Financ Rev. 2006 Fall;28(1):25-40
17290666
Milbank Q. 2002;80(2):261-301
12101873
Health Aff (Millwood). 2009 Sep-Oct;28(5):w822-31
19635784
Public Health Rep. 1998 Mar-Apr;113(2):140-51
9719815
Health Aff (Millwood). 2001 Nov-Dec;20(6):146-60
11816653
Milbank Q. 2007 Dec;85(4):579-610
18070331
Health Care Financ Rev. 1999 Summer;20(4):179-96
11482121
Milbank Q. 2006;84(3):493-520
16953808