Sophie Mitra

Health Care Expenditures of Living With a Disability: Total Expenditures, Out-of-Pocket Expenses, and Burden, 1996 to 2004

OBJECTIVE To estimate the health care expenditures associated with a disability and their recent trends. DESIGN Retrospective analysis of survey data. SETTING Not applicable. PARTICIPANTS Data from multiple years (1996-2004) of the Medical Expenditure Panel Survey (MEPS) for a nationally representative sample of civilian, noninstitutionalized U.S. population. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Health care expenditures consisted of total health care expenditures, total out-of-pocket (OOP) spending, and burden (the ratio of OOP to family income). All the analyses accounted for the complex survey design of the MEPS. RESULTS Between 1996 and 2004, 6% to 9% of persons in the working-age group (21-61 y) were identified as having a disability. Persons with disabilities consistently had higher total health expenditures, OOP spending, and burden compared with their counterparts without disabilities. In 2004, the average total expenditures were estimated at

Disability and Social Safety Nets in Developing Countries

10,508 for persons with disabilities and at

Disability Prevalence Among Adults: Estimates for 54 Countries and Progress Towards a Global Estimate

2256 for those without disabilities. In a multiple regression framework, persons with disabilities were consistently found to have higher expenditures, OOP spending, and burden between 1996 and 2004. Although expenditures, OOP spending, and burden increased over time, after controlling for demographic, socioeconomic, and health status, these 3 health care costs were not found to change disproportionately for persons with disability. CONCLUSIONS During the 1996 to 2004 period, persons with disabilities were consistently found to have significantly higher health expenditures, OOP spending, and burden compared with their counterparts without disabilities, which may adversely affect their health and standard of living.

Is There a Disability Gap in Employment Rates in Developing Countries

This paper deals with how social safety nets may reach the poor with disabilities in developing countries. It presents a framework for analyzing the inclusion of disability in social safety nets. The paper first reviews evidence on the relation between disability and poverty, and, discusses the roles that safety nets may play with regard to disability. Safety nets can reach persons with disabilities through inclusive mainstream programs, as well as disability targeted programs. The advantages and challenges of disability targeting are then discussed. The paper proceeds to analyze different ways that can be used to include disability considerations in the implementation of mainstream safety nets, through the reduction of physical, communication, and social barriers surrounding such programs, and through the careful design and evaluation of safety nets. The use of disability targeting versus, or in combination with disability mainstreaming is then discussed.

The Economic Lives of People with Disabilities in Vietnam

Objectives: We estimated disability prevalence among adults at global, regional and country levels using internationally comparable disability data and measure. Methods: We conducted a retrospective analysis of data from the World Health Survey (WHS) (2002-2004) for nationally representative samples of civilian, non-institutionalized populations in 54 countries. A disability was measured as having at least one severe or extreme difficulty with bodily functions (seeing, concentrating) and activities (moving around, self-care) based on an individual’s self-reports. Results: In the 54 countries under study, severe or extreme functional or activity difficulties are highly prevalent. For all countries, disability prevalence is estimated at 14% for all adults. Low and middle income countries have higher disability prevalence compared to high income countries. Among subgroups, disability prevalence stands at 12% among working age adults and 39% among the elderly. Women have higher prevalence than men. Conclusions: Disability is found to be highly prevalent among adults, with an estimated global prevalence at 14%. Disability deserves enhanced policy attention and resources in public health and international development.

The Recent Decline In The Employment Of Persons With Disabilities In South Africa, 1998-2006

This paper examines differences in employment rates between persons with and without disabilities in 15 developing countries using the World Health Survey. We find that people with disabilities have lower employment rates than persons without disabilities in nine countries. Across countries, disability gaps in employment rates are more often found for men than women. The largest disability gap in employment rates is found for persons with multiple disabilities. For countries with a disability gap, results from a logistic decomposition suggest that observable characteristics of persons with/without disabilities do not explain most of the gap.

Implementing a Multidimensional Poverty Measure Using Mixed Methods and a Participatory Framework.

Through a series of focus group discussions conducted in northern and central Vietnam, this study gives voice to the lived economic experience of families with disabilities and how they manage the economic challenges associated with disability. The dynamic of low and unstable income combined with on-going health care and other disability-related costs gives rise to a range of coping mechanisms (borrowing, reducing and foregoing expenditures, drawing upon savings and substituting labour) that helps to maintain living standards in the short-run yet threatens the longer-term welfare of both the individual with disability and their household. Current social protection programs were reported as not accessible to all and while addressing some immediate economic costs of disability, do not successfully meet current needs nor accommodate wider barriers to availing benefits.

The impact of health insurance for children under age 6 in Vietnam: A regression discontinuity approach

This paper shows that there has been a significant decline in the employment and labor force participation of persons with disabilities in South Africa over the 1998 through 2006 period. Disability is defined based on activity limitations. Data are from the October and the General Household Surveys. The paper also deals with the possible causes of the decline. While several causes can be invoked, preliminary evidence suggests that the rise of the Disability Grant program might be responsible for a part of the decline. Recommendations are made for future research and data collection on disability and employment.

Disability Screening and Labor Supply: Evidence from South Africa

Recently, there have been advances in the development of multidimensional poverty measures. Work is needed however on how to implement such measures. This paper deals with the process of selecting dimensions and setting weights in multidimensional poverty measurement using qualitative and quantitative methods in a participatory framework. We estimate the multidimensional poverty measures developed by Alkire and Foster for a particular group: persons with psychiatric diagnoses in the United States. To select relevant dimensions and their relative ordering, two discussion groups are convened: one consisting of persons with lived-experience expertise and the other consisting of people with mental health service provision or research expertise. Several methods are used to convert dimension rankings into weights. The selection and ordering of dimensions differed between the two discussion groups, as did the resulting poverty measures. For instance, the poverty headcount using the dimensions and weights of the ‘lived experience’ group ranged from 20.61 to 26.96% as compared to a range of 18.62–33.19% using those of the ‘provider/researcher’ group. One of the main results of this study is that the Alkire Foster method is sensitive to the selection of dimensions and the methods used to derive rankings and weights. It points toward the limitation of relying exclusively on small scale qualitative methods for the selection and ranking of dimensions. In addition, the participatory framework used in this study was found to be essential in interpreting results, in particular with respect to the limitations of the data set in measuring relevant dimensions. Copyright Springer Science+Business Media B.V. 2013

Wage differential by disability status in an agrarian labour market in India.

Accessing health services at an early age is important to future health and life outcomes. Yet, little is currently known on the role of health insurance in facilitating access to care for children. Exploiting a regression discontinuity design made possible through a policy to provide health insurance to pre-school aged children in Vietnam, this paper evaluates the impact of health insurance on the health care utilization outcomes of children at the eligibility threshold of six years. Using three rounds of the Vietnam Household Living Standards Survey, the study finds a positive impact on inpatient and outpatient visits and no significant impact on expenditures per visit at public facilities. We find moderately high use of private outpatient services and no evidence of a switch from private to covered public facilities under insurance. Results suggest that adopting public health insurance programs for children under age 6 may be an important vehicle to improving service utilization in a low- and middle-income country context. Challenges remain in providing adequate protections from the costs and other barriers to care.