Date of Award


Document Type

Campus Access Dissertation


Health Promotion, Education and Behavior

First Advisor

Janice C Probst


Background:Working-age adults with disabilities who tend to be socioeconomic disadvantaged account for a disproportionate share of publically funded health care services and expenditures. Prescription drug costs are also one of the most significant expenses for those with disabilities and may impose an extensive financial burden on them. However, data on health care costs among them are sparse. Previous research has not explored differences in health care cost burden across differing lengths of disability.

Objectives:To assess the effect of three types of disability status (persistent disability, temporary disability, and no disability) on total and service 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 total and service expenditures, OOP expenditures, and financial ratios were weighted and compared across the 3 groups. The package R was used for quantile regression analyses to estimate the effect of disability status on outcome variables while controlling for respondent characteristics.

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 21% and 22% 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 1,622, 147, 0.59 respectively) relative to the no disability group at the 50th percentile. Results for the temporary disability group show a similar trend. In addition, at the 50th percentile, the persistent disability group had higher Rx expenditures, OOP expenses, and financial burden ratios (coefficients 361, 54, and 0.24 respectively, p

Conclusions:Longer disability spans are associated with additional health care use, costs, OOP spending, and financial burden but better financial protection against OOP expenses relative to costs. More effective health care policies which limit OOP spending and adjust cost sharing and premiums according to income are needed to reduce inequalities in health care financial burden between the disabled and non-disabled populations.


© 2012, Chaiporn Pumkam