Health Care Expenditures of Community-Dwelling Adults with Disabilities Open Access
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Problem:The World Health Organization's (WHO's)International Classification of Diseases(ICD) has traditionally been recognized as a global standard for diagnostic classification used for health and vital records. The newer International Classification of Functioning, Disability and Health(ICF) provides an international, unified framework and standard language for functional classification of disability. The ICF complements ICD codes by providing functional information using ICF dimensions of activities and participation within the context of the environment. Changes in the interpretation of the definition of disability under the Americans with Disabilities Act Amendments Act (ADAAA) and the Institute of Medicine's recommendation of the adoption of the ICF as a conceptual framework for disability monitoring and research brings new challenges to the identification, classification, and measurement of persons with disabilities for analytical research, provision of health services, and health policy applications. Objective: The objective of this study is to examine the efficacy of the use of ICF for public health policy applications. Study Design and Methods: This retrospective database study examined the relationship of health and functional status information from the ICF codes for activities, participation, and the environment to ICD codes in predicting health care expenditures for community-dwelling adults, age 22-64 years old (n = 16,974). The study hypothesized that activities and participation within the context of the environment moderate the effect of physically disabling conditions on total health care expenditures for community-dwelling adults. The analysis utilized an internationally recognized procedure for linking ICF classification codes and the Medical Expenditure Panel Survey, a national survey of household community-based health care expenditures to describe the relationship between total health expenditures and treated physically disabling conditions and function within the context of the environment.Results: This research provides national estimates of community-dwelling adults, age 22-64 years old with treated physically disabling conditions, calculated to reflect the broadened interpretation of the definition of disability under the ADAAA. Conditional mean expenditures are provided for total, in-patient, ambulatory care, prescription medication, dental, and other medical care expenditures. The environment component of the ICF contributes towards total health care expenditures for community-dwelling adults, age 22-64 years old.