title: Patterns of healthcare use and employment among people with disabilities.
abstract: BACKGROUND
  Employment rates among people with disabilities are low. Poor health is often cited as a barrier to work. Disability or a lack of disability-related resources may interfere with the ability to secure and maintain work.
  
  
  OBJECTIVE
  This paper presents an exploratory examination of the association between variation in service use and employment.
  
  
  METHODS
  The paper uses data from North Carolina Medicaid recipients age 18-64 who were eligible in fiscal year 2007 due to receipt of Supplemental Security Income (n = 60,190). Logistic regression was used to model employment as a function of variation in healthcare use, with conditional models stratifying by days of service use and unconditional models run by quantile of service use.
  
  
  RESULTS
  People with the least service use (< 12 days) had the highest employment rate (over 20%); those with the most service use (≥54 days) had the lowest employment rate (7.8%). Those in between displayed remarkably little variation in employment rate by level of service use. The amount of week-to-week variation in service use was positively associated with the probability of employment.
  
  
  CONCLUSIONS
  Among Medicaid enrollees with disabilities who use outpatient services, amount of service use is negatively associated with employment and variation in use is positively associated with employment. Future research involving more extensive administrative data, primary data collection, and the use of mixed methods would improve understanding of these findings.
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA. Kathleen_thomas@unc.edu
authors.forename: Kathleen C
authors.initials: KC
authors.lastname: Thomas
authors.forename: Alan R
authors.initials: AR
authors.lastname: Ellis
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D006233:Persons with Disabilities; D004651:Employment; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D009657:North Carolina; D010342:Patient Acceptance of Health Care; D014481:United States; D055815:Young Adult