RESEARCH INFORMATION ON INDEPENDENT LIVING
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Volume 1, Issue 5

Managed Care & Disability

Numerous studies point to the disability field's apprehension about managed care and its effects on people with disabilities. Questioning burgeoned in the mid 1990s and remains as study data accumulate and lawsuits determine consumer rights and discriminatory practices.

Reports consistently acknowledge the need to control medical costs and increase care accountability. But a suspected decline in specialist use, medical reluctance to treat chronic health problems, care access barriers, nurse reduction that   limits home health care, caps on treatment, frequent refusal of assistive technology, built-in incentives to underserve, targeting of acute rather than comprehensive care, and other program minuses have created a climate of activated concern.

For example, recent research findings report that:

 ·        Lower-income and elderly patients both tend to decline in health with managed care over fee-for-service medical care. This decline could be related to shorter visits, suggested researchers from New England Medical Center in Boston.

·        The medical profession's ethic of undivided loyalty to patients has diminished since 1991, according to a study of 1,500 physicians of the Institute for Bioethics at New York Medical.

·        Rural residents often get shortchanged in medical services, because managed care service areas are typically near large metropolitans. Managed care companies can claim and even enroll rural residents in areas without providers and services, indicates research from the Rehabilitation Research and Training Center on Rural Rehabilitation Services at The University of Montana.

 A common conclusion of many of these reports is the need for vigilant advocacy involving services coverage, grievance procedures, and judging criteria.

Centers for independent living can help consumers in the advocacy process. They can do more than help advocate — two centers in Wisconsin have even established separate organizations to provide managed care services for people with disabilities.

Friend or foe? The impact of managed health care on people with disabilities and independent living remains undecided. —  Cindy Higgins, The Research and Training Center on Independent Living, The University of Kansas, 1000 Sunnyside Ave., Room 4089 Dole Center, Lawrence, KS 66045-7555, (785) 864-4095, E-mail: [email protected]. This project funded by National Institute on Disability Rehabilitation Research grant #H133A980048.

Information for this review came from the interactive Research Information on Independent Living (RIIL) database at www.GetRiil.org, which contains research summaries related to independent living with disabilities. A special effort has been made to include information that independent leaders in the field said they wanted, namely topics regarding accessible, affordable housing, effective advocacy for rural areas, effective transition from schools and nursing homes, accessible, affordable transportation, reaching underserved populations, policies that impede independent living, rural health care services, and Medicaid/Medicare regulations for durable equipment.

 RIIL is a joint effort of the Research and Training Center on Independent Living at the University of Kansas and the Independent Living Research Utilization (ILRU) Program of TIRR.