title: Disparities in wheelchair procurement by payer among people with spinal cord injury.
abstract: OBJECTIVE
  To identify insurance provider-related disparities in the receipt of lightweight, customizable manual wheelchairs or power wheelchairs with programmable controls among community-dwelling people with spinal cord injury (SCI).
  
  
  METHODS
  Six Spinal Cord Injury Model System centers.
  
  
  METHODS
  A multicenter cross-sectional study.
  
  
  METHODS
  A total of 359 individuals at least 16 years of age or older and 1 year after SCI who use a manual or power wheelchair as their primary means of mobility. The subjects were stratified by payer, and payers were grouped according to reimbursement characteristics as follows: Medicaid/Department of Vocational Rehabilitation (DVR), private/prepaid, Medicare, Worker's Compensation (WC)/Veterans Affairs (VA), and self pay.
  
  
  METHODS
  Demographic, wheelchair, and payer data were collected by medical record review and face-to-face interview.
  
  
  RESULTS
  There were 125 participants in the Medicaid/DVR group, 120 in the private/prepaid group, 55 in the Medicare group, 30 in the WC/VA group, and 29 in the self-pay group. For manual wheelchair users, the likelihood of having a lightweight, customizable wheelchair was 97.5% for private/prepaid, 96.3% for Medicaid/DVR, 94.1% for WC/VA, 87.5% for Medicare, and 82.6% for self pay. For power wheelchair users, those with WC/VA (100%) were most likely to receive a customizable power wheelchair with programmable controls, followed by private/prepaid (95.1%), Medicaid/DVR (86.0 %), Medicare (83.9%), and self pay (50.0%).
  
  
  CONCLUSIONS
  The only payer group for which all beneficiaries received wheelchairs that met standard of care were power wheelchairs provided by WC/VA. Fewer than 90% of people whose manual wheelchair was paid for by Medicare and self pay, and whose power wheelchair was paid for by Medicaid/DVR, Medicare, and self pay did not meet standard of care. Although these findings need to be correlated with long-term risks, such as overuse injuries, breakdowns, and participation, this study demonstrates that disparities in wheelchair procurement by insurance provider persist.
authors.affiliation: Physical Medicine and Rehabilitation, National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010(∗). Electronic address: suzanne.l.groah@medstar.net.
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Groah
authors.affiliation: MedStar National Rehabilitation Hospital, Washington, DC(†).
authors.forename: Inger
authors.initials: I
authors.lastname: Ljungberg
authors.affiliation: MedStar National Rehabilitation Hospital, Washington, DC(‡).
authors.forename: Alison
authors.initials: A
authors.lastname: Lichy
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; School of Medicine and Center of Excellence in Wheelchairs and Associated Rehabilitation Engineering, VA Pittsburgh Healthcare System, Pittsburgh, PA(§).
authors.forename: Michelle
authors.initials: M
authors.lastname: Oyster
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; School of Medicine and Center of Excellence in Wheelchairs and Associated Rehabilitation Engineering, VA Pittsburgh Healthcare System, Pittsburgh, PA(¶).
authors.forename: Michael L
authors.initials: ML
authors.lastname: Boninger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D055615:Electrical Equipment and Supplies / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D010264:Paraplegia / Q000453:epidemiology; D011782:Quadriplegia / Q000453:epidemiology; D044469:Racial Groups / Q000706:statistics & numerical data; D013119:Spinal Cord Injuries / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014729:Veterans Disability Claims / Q000706:statistics & numerical data; D014910:Wheelchairs / Q000191:economics* / Q000706:statistics & numerical data*; D014942:Workers' Compensation / Q000706:statistics & numerical data; D055815:Young Adult