Disability and under-insurance for medical care among working age adults

BACKGROUND: Individuals with disabilities are consistently found to have significantly higher out-of-pocket spending on healthcare compared to their counterparts without disabilities which may adversely affect their health and standard of living.

OBJECTIVE: Evaluate underinsurance for healthcare spending among individuals with disability and examine subgroups of individuals with disability who are at risk for underinsurance for healthcare.

METHODS: Cross-sectional data on 13,186 individuals aged between 22 and 64 from the 2005 Medical Expenditure Panel Survey. Disability is measured as having at least one major activity limitation. Underinsurance for healthcare is measured as the proportion of out-of-pocket spending to total healthcare expenditures, which was categorized into six groups. Chi-square tests and multinomial logistic regression were used to examine the association between disability and under insurance and to identify individuals at risk for underinsurance among those with disability. Further analyses will examine out-of-pocket as a percent of income and additionally analyze all measures of under-insurance in subsamples of persons with disabilities by labor force and beneficiary status.

FINDINGS: Overall, 10% had disability. So far, we did not find significant differences by disability among those who spent out of pocket over 60% of total healthcare expenditures. Among those with disability, older individuals, living with spouse, and those with mental illness were more likely to have underinsurance.

CONCLUSION: Overall, working age individuals with disability were as likely as those without disability to have underinsurance measured as spending greater than 60% of total expenditures out-of-pocket. However, some subgroups of individuals with disability were vulnerable for underinsurance.