title: Implications of prosthesis funding structures on the use of prostheses: experiences of individuals with upper limb absence.
abstract: BACKGROUND
  While sparsely researched, funding structures may play an important role in use of and satisfaction with prostheses and related health services.
  
  
  OBJECTIVE
  The objectives of this study were to (1) quantify the direct costs of prosthesis wear, (2) explore variations in funding distribution, and (3) describe the role of affordability in prosthesis selection and wear.
  
  
  METHODS
  An anonymous, online cross-sectional descriptive survey was administered.
  
  
  METHODS
  Analyses were conducted of qualitative and quantitative data extracted from an international sample of 242 individuals with upper limb absence.
  
  
  RESULTS
  Access to prosthesis funding was variable and fluctuated with age, level of limb absence and country of care. Of individuals who gave details on prosthetic costs, 63% (n = 69) were fully reimbursed for their prosthetic expenses, while 37% (n = 40) were financially disadvantaged by the cost of components (mean [SD] US$9,574 [$9,986]) and their ongoing maintenance (US$1,936 [$3,179]). Of the 71 non-wearers in this study, 48% considered cost an influential factor in their decision not to adopt prosthesis use.
  
  
  CONCLUSIONS
  Prosthesis funding is neither homogeneous nor transparent and can be influential in both the selection and use of a prosthetic device.
  
  
  CONCLUSIONS
  Inequitable access to prosthesis funding is evident in industrialized nations and may lead to prosthesis abandonment and/or diminished quality of life for individuals with upper limb absences. Increased efforts are required to ensure equitable access to upper limb prosthetics and related services in line with individuals' needs.
authors.affiliation: Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada. ebiddiss@hollandbloorview.ca
authors.forename: Elaine
authors.initials: E
authors.lastname: Biddiss
authors.forename: Patricia
authors.initials: P
authors.lastname: McKeever
authors.forename: Sally
authors.initials: S
authors.lastname: Lindsay
authors.forename: Tom
authors.initials: T
authors.lastname: Chau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000674:Amputees; D001186:Artificial Limbs / Q000191:economics* / Q000706:statistics & numerical data*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D007223:Infant; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007802:Language; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care / Q000191:economics; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult