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COPYRIGHT 2006 Pro-Ed
People with disabilities make up approximately 20% of the U.S. population but account for 47% of total medical expenditures (Max, Rice, & Trupin, 1996). Health promotion programs represent one strategy for both improving health and containing medical costs for this population. This study examined the financial net benefits of the Living Well with a Disability health promotion program from the perspective of a third-party payer. Net benefits were defined as reductions in health-care utilization costs minus program implementation costs. The study sample consisted of 188 people with physical disabilities who completed the Living Well health promotion program. Health-care cost outcomes were collected using a 2-month retrospective recall of health-care services multiplied by Medicare unit cost estimates. The net benefits for the first 6 months postintervention were $2,631 per person for the entire cohort and $127 per person for a trimmed data set. The results suggested positive financial benefits and provide grounds for further research about third-party payer support of health promotion programs for individuals with physical disabilities.
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Health promotion programs represent one strategy for both improving health and containing medical care expenditures. Several privately sponsored health promotion evaluations have demonstrated the efficacious and cost-effective merits of this strategy. Most of these health promotion studies, however, have been conducted in work-site settings for a relatively healthy population (Aldana, 2001; Aldana, Jacobson, Harris, Kelley, & Stone, 1993; Bertera, 1993; Fries, Harrington, Edwards, Kent, & Richardson, 1994; Pelletier, 1996; Pelletier, 2001; Sciacca, Seehafer, Reed, & Mulvaney, 1993; Shephard, 1989; Shi, 1993). This focus on health promotion for employed adults excludes many individuals with disabilities or chronic conditions who do not work and who rely on federal assistance programs to address their health-care needs.
Census 2000 figures estimate that 43.4% of the population with disabilities ages 21 to 64 are not employed, versus 22.8% of the population without disabilities ages 21 to 64 (U.S. Census Bureau, 2000). Furthermore, the 1998 Chartbook on Work and Disability estimates that 72.5% of individuals with severe disabilities do not work (Stoddard, Jans, Ripple, & Kraus, 1998). Low rates of employment for people with disabilities coincide with per capita medical costs that are 3 times higher than for individuals without chronic conditions (Gordon & Lapin, 2001; Hoffman, Rice, & Sung, 1996).
Health promotion interventions have been linked to reduced medical expenditures for at-risk populations (Aldana, 2001; Pelletier, 2001, Pronk, Goodman, O'Conner, & Martinson, 1999). Economic cost and feasibility analyses of health promotion programs outside the work site, however, are rare (Rimmer, 1999; Taylor, Baranowski, & Young, 1998). One possible reason that health promotion efforts are not supported through federal programs like Medicare and Medicaid is a lack of evidence about the financial costs and benefits associated with program participation by people with disabilities (Guo, Gibson, Gropper, Oswald, & Barker, 1998; Hoffman et al., 1996).
Because many individuals with disabilities are not employed and consequently do not have the financial resources to pay for health promotion services, they must rely on third-party payer support to access programs. If health promotion can be shown to reduce medical expenses or increase baseline health, insurance programs (including social programs like Medicare and Medicaid) may be more willing to cover participation costs. One such program, Living Well with a Disability, has been shown to be effective in reducing limitations due to secondary conditions (Ravesloot, Seekins, Ipsen, Seninger, Murphy-Southwick, Brennan, et al., 2003).
This article responds to this need by focusing on the financial cost-benefits of a health promotion program aimed specifically at individuals with physical disabilities. It explores 6-month net benefits, defined as change in medical care utilization costs (program outcomes) minus direct costs to implement the Living Well health promotion program (programmatic costs). Although the short time horizon excludes longer-term health outcomes, it provides net benefit results that are most likely to be realized by the third party who is paying for the costs of the health promotion investment. Additionally, short-term outcomes can be more confidently attributed to program participation.
Method
Settings and Participants
The Living Well workshop was delivered at Centers for Independent Living (CILs), community-based organizations that provide services and advocacy for people with disabilities. CILs were invited to participate in this project through a national mini-grant competition. One hundred six completed applications were received. A screening process by researchers, Centers for Disease Control and Prevention staff, and CIL membership resulted in the selection of nine CILs representing rural and urban regions as well as southern- and northern-tier states. Additionally, census data indicate that selected states represent high and low per capita income and education levels (U.S. Census Bureau, 1999).
Each CIL received a contract to complete four replications of the Living Well workshop. This contract included CIL facilitator training, Living Well workbooks, and reimbursement for each replication of Living Well to cover staff salary, meeting space, refreshments, and other incidentals. Workshops were conducted by teams of two facilitators (two CIL staff, or one CIL staff and one peer) in eight weekly 2-hr sessions. Each session included a lecture, in-class assignments, and group sharing.
Living Well workshop facilitators were responsible for participant recruitment. Recruitment efforts included letters and personal communications between facilitators and CIL constituents, posted flyers, media contacts (including news releases and public service announcements), and referrals from medical service providers who received information packets about the workshops. Each CIL facilitator performed two rounds of recruitment during the 2-year study (1998 and 1999). Small and declining recruitment levels were a problem because the Living Well program was designed to serve up to 12 participants per replication, but facilitators recruited an average of only 7.2 participants per workshop. Overall, a total of 246 people with disabilities were recruited to participate in the workshops.
Because this study focused on the longitudinal change of health outcomes for people who participated in the Living Well intervention, the study sample was confined to 188 participants who provided both immediate preintervention and immediate postintervention survey data. An additional 58 participants enrolled in the...
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