Health Services Use and Costs for Americans With Intellectual and Developmental Disabilities: A National Analysis

Abstract

Health services and associated costs for adults with intellectual and developmental disabilities (IDD) were nationally profiled and the predictors of high expense users statistically modeled. Using linked data from the National Health Interview Survey and Medical Expenditure Panel Survey for the years 2002 through 2011, the study found a mixed pattern of differences in rates of service use and costs when compared to the general population depending upon personal characteristics, health status, and type of health care service. Prescription medication costs were the primary driver of total health care expenditures for Americans with IDD. The presence of secondary chronic health conditions and poor mental health status were the consistent predictors of high expense users across types of health care. Study results are discussed in terms of implications for more nuanced evaluations of health care costs and need for recurring surveillance of health care for Americans with IDD in the years following passage of the Patient Protection and Affordable Care Act.

State-Level Health Care Expenditures Associated With Disability

“…6 We controlled for sociodemographic characteristics but did not control for other health conditions to capture data on health care spending on diseases for which disability may be a risk factor. 21,22 We estimated DAHE per person with disability (PWD) using the counterfactual approach. 6 We also used MEPS data to estimate a multinomial logit model predicting health insurance category.…”

“…We intentionally did not control for health conditions when estimating DAHE because we wanted to capture downstream cost effects of those conditions among people with disabilities, who may be at a higher risk of developing certain chronic conditions. 21,22…”

Applied behavior analysis and intellectual and developmental disabilities.

“…Individuals with IDD often have worsened health outcomes, including higher rates of obesity and diabetes, lower life expectancies, and higher rates of chronic conditions in comparison with the general population (see Chapter 18, this volume). In one review of health expenditures for individuals with IDD, Fujiura et al (2018) found that chronic conditions and poor mental health status were predictors of increased service utilization. Also, for individuals with IDD, medication accounts for a higher percentage of spending (36% vs. 21%) than it does for their same-age typically developing counterparts.…”

“…Also, for individuals with IDD, medication accounts for a higher percentage of spending (36% vs. 21%) than it does for their same-age typically developing counterparts. While some of this difference may be attributable to comorbid disorders, there is also a pronounced services gap for this population (Fujiura et al, 2018). One related disparity centers on the administration of screening and diagnostic procedures.…”

Small Steps in Fitness, Major Leaps in Health for Adults With Intellectual Disabilities

“…As both the identification and treatment of several health conditions in individuals with intellectual disabilities have improved over time, the life expectancy of the majority of this population is currently close to the life expectancy of the general population [11]. This further aggravates the impact of the increased care and support needs [12], both on an individual level as on population level, with health care costs substantially increasing in the last decades of life. As the disabilityassociated health-care expenditures of individuals with disabilities currently comprise around 25% of the total US annual health care spending [13], any means of reducing these costs would be of major interest to both the individuals involved as to policy makers.…”