Prescription and repair rates of prosthetic limbs in the VA healthcare system: implications for national prosthetic parity.
OBJECTIVE
To quantify prescription and repair rates of prosthetic limbs in the Department of Veterans Affairs (VA) and explore differences by level, type, and age.


METHODS
Veterans (N = 32 440) with an initial prosthetic prescription between 2000 and 2010 were classified by amputation level and type. Annual rates of prescription and repair were calculated using person-time and compared by group.


RESULTS
Veterans with upper limb amputation had lower annual prescription and repair rates (0.28 and 0.21) compared with those with lower limb amputation (0.40 and 0.56). Myoelectric devices users had higher prescription rates. However, body-powered users had higher repair rates. Prescription and repair rates for microprocessor knee joints were higher than for fluid and friction devices. Veterans under 65 had 0.07 and 0.16 higher rates of prescription and repair than those over 65 (p < 0.0001).


CONCLUSIONS
Because the VA is unconstrained by co-pays or caps, data on prosthetic prescription and repair can be used to estimate rates that might occur if national prosthetic parity laws were adopted. Given the rates found, it is likely that annual costs would exceed the typical annual and/or lifetime caps in most insurance plans. In states without prosthetic parity laws, such costs likely limit access to needed devices. Implications for Rehabilitation For the almost 2 million people in the United States living with an amputation or congenital limb loss, purchasing and maintaining a prosthetic limb can be costly, with insurances often imposing annual or lifetime caps. Data on prosthetic purchasing and repair is limited and reliant on self-reported information. Because the VA is unconstrained by co-pays or caps, claims data on prosthetic prescription and repair can be used to estimate rates that might occur if national prosthetic parity laws were adopted. Given the rates found, it is likely that annual costs would exceed the typical annual and/or lifetime caps in most insurance plans. In states without prosthetic parity laws, such costs likely limit access to needed devices.
a Department of Health Services , Policy and Practice, Brown University , Providence , RI , USA and.|b Providence VA Medical Center , Providence , RI , USA.
Katherine
K
Etter
b Providence VA Medical Center , Providence , RI , USA.
Matthew
M
Borgia
a Department of Health Services , Policy and Practice, Brown University , Providence , RI , USA and.|b Providence VA Medical Center , Providence , RI , USA.
Linda
L
Resnik
Amputee; Veterans; assistive technology; insurance; prosthesis