The Future of Disability in America (2007) / Chapter Skim
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Pages 1-15
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Summary Today, between 40 million and 50 million people in the United States report some kind of disability. That number will likely grow significantly in the next 30 years as the baby boom generation enters late life, when the risk of disability is the highest.
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As agreed upon with the study's sponsors, the review focused on several topics, including · methodological and policy issues related to the definition, measurement, and monitoring of disability; · trends in the amount, types, and causes of disability; · secondary health conditions and aging with disability; · transitions for young people with disabilities from pediatric to adult health care services; · assistive technologies and supportive physical environments; · coverage of assistive technologies and risk adjustment of payments to health plans; and · directions for research. The committee concluded that the United States has seen some progress since the publication of the earlier IOM reports.
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Despite modest increases in funding during the late 1990s, research spending on disability is miniscule in relation to current and future needs. Medicare, Medicaid, and private health plans continue to apply outdated policies that restrict access to assistive technologies and services.
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NOTE: CDC = Centers for Disease Control and Prevention; BLS = Bureau of Labor Statistics, NIH = National Institutes of Health; NIDRR = National Institute on Disability and Rehabilitation Research; AHRQ = Agency for Healthcare Research and Quality; VHA = Veterans Health Administration; DHHS = U.S. Department of Health and Human Services; ICDR = Interagency Committee on Disability Research; MCHB = Maternal and Child Health Bureau; Access Board = Architectural and Transportation Barriers Compliance Board; SSA = Social Security Administration.
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The lack of a comprehensive disability monitoring program, highlighted in the 1991 IOM report, remains a serious shortcoming in the nation's health statistics system. Today, disability statistics must be patched together from multiple, often inconsistent surveys.
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It should also issue and widely disseminate guidelines for health care professionals and executives that describe the government's expectations for compliance with the ADA. Likewise, the Joint Commission and other organizations that accredit health
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One persistent problem with government efforts to promote competition among managed care and other health plans and to enroll people with disabilities in such plans is that the methods that Medicare and Medicaid use to pay health plans have overpaid for individuals with few health conditions and underpaid for people with serious health conditions or disabilities. Despite recent improvements in Medicare's method for the risk adjustment of health plan payments, it remains financially more attractive for health plans to seek low-risk beneficiaries than to provide efficient, highquality care to people with chronic health conditions and disabilities.
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Congress should extend Medicaid and State Children's Health Insurance Program coverage through age 21 for all beneficiaries with chronic conditions or disabilities and should specify that program benefits cover appropriate transition assessment, coordination, and management services for these young people. PUBLIC AND PROFESSIONAL EDUCATION Develop educational programs, evidence-based reviews, practice guidelines, and other materials to support health professionals in caring for people with disabilities.
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These reviews can be used as the basis for collaborative efforts by professional societies, people with disabilities, and others to formulate evidence-based guidelines clinical practice guidelines, guides for consumers, and other educational materials. Launch a national public health campaign to increase public and health care professional awareness of assistive and accessible technologies.
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These improved data sources should serve as the cornerstone of a new national disability monitoring system. Health Care Transitions, Secondary Conditions, and Aging with Disability Recommendation 4.1: To improve the transition of young people with disabilities from pediatric to adult health care, policy makers, professional societies, public and private payers, and educators should work to • align and strengthen incentives in public and private health care programs to support coordinated care and transition planning; • expand the use of integrated electronic medical records for chronic disease management and during the transition of young people with disabilities from pediatric to adult health care; and • expand chronic care education in pediatric and internal medicine
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Maternal and Child Health Bureau to expand its work to develop and implement medical home and other services for young people with special health care needs who are over age 21 and who need continued transition support; • revise the Ticket to Work program by lowering the eligibility age to 16 years and directing the U.S. Department of Education and the Social Security Administration to develop guidance for the coordination of Ticket to Work services with the transition services and supports provided under the Individuals with Disabilities Education Act; and • direct the Centers for Disease Control and Prevention to work with other relevant agencies to examine opportunities for the monitoring of transitions through additions to state and national youth surveys or other cross-sectional and longitudinal data collection efforts.
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Department of Justice should issue and widely disseminate guidelines for health care providers that describe expectations for compliance with the accessibility provisions of the act; and • the Joint Commission and other organizations that accredit or set federal program participation conditions for health care organizations should explicitly consider compliance with federal accessibility standards and guidelines in making their accreditation and participation decisions. Recommendation 6.3: The U.S.
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Recommendation 7.3: The Centers for Disease Control and Prevention, working with the National Institute on Disability and Rehabilitation Research, should launch a major public health campaign to increase public and health professional awareness and acceptance of assistive technologies and accessible mainstream technologies that can benefit people with different kinds of disabilities. Recommendation 8.1: The U.S.
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Priorities include • eliminating or modifying Medicare's "in-home-use" requirement for durable medical equipment and revising coverage criteria to consider the contribution of these devices and equipment to an individual's independence and participation in community life; • evaluating new approaches for supplying assistive technologies (such as time-limited rentals and recycling of used equipment) and providing timely and appropriate equipment repairs; and • continuing research to assess and improve the appropriateness, quality, and cost-effectiveness of the assistive services and technologies provided to people with disabilities.
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Department of Education to support the National Institute on Disability and Rehabilitation Research in continuing to upgrade its research review process and grants program administration. Recommendation 10.3: To facilitate cross-agency strategic planning and priority setting around disability research and to expand efforts to reduce duplication across agencies engaged in disability research, the U.S.
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