Health care expenditures among working-age adults with disabilities: Variations by disability spans

Background: Data on health care costs for working-age adults with disabilities are sparse and the dynamic nature of disability is not captured. Objectives: To assess the effect of three types of disability status (persistent disability, temporary disability, and no disability) on health care expenditures, out-of-pocket (OOP) spending, and financial burden. Methods: Data from Medical Expenditure Panel Survey panel 12 (2007-2008) were used. Respondents were classified into 3 groups. Medians of average annual expenditures, OOP expenditures, and financial ratios were weighted. The package “R” was used for quantile regression analyses. Results: 14% of the working-age population reported persistent disabilities and 11% had temporary disabilities. The persistent disability group had the greatest unadjusted annual medians for total expenditures ($4,234), OOP expenses ($591), and financial burden ratios (1.59), followed by the temporary disability group ($1,829, $423, 0.75 respectively). The persistent disability group paid approximately 14% of total health care expenditures out-of-pocket, while the temporary disability group and the no disability group each paid 23% and 25% out-of-pocket. After adjusting for other factors, quantile regression shows that the persistent disability group had significantly higher total expenditures, OOP expenses, and financial burden ratios (coefficients 1,621.72, 146.91, 0.59 respectively) relative to the no disability group at the 50th percentile. Results for the temporary disability group show a similar trend. Conclusions: People who have disabling conditions for a long period have better financial protection against OOP health care expenses but face high financial burdens because of their higher needs for health care services and their socioeconomic disadvantages.