Health Care Utilization Patterns Among Adults With or Without Functional Disabilities
Authors: Sungchul Park, Jim P. Stimpson, A. Mark Fendrick
Journal: JAMA Network Open (2025)

Importance Adults with functional disabilities require more medical care, but it remains unclear whether they use more health services, including high- and low-value services. Objectives To examine health care utilization by functional disability among US adults. Design, Setting, and Participants This cross-sectional study analyzed data from the 2013 to 2021 Medical Expenditure Panel Survey. The sample comprised noninstitutionalized US civilians aged 18 years or older. Statistical analysis was conducted between May and October 2024. Exposures Self-reported functional disability. Functional disability was assessed through 6 questions on difficulties (with vision, hearing, memory or concentration, walking, self-care, and performing errands) and categorized as no (0 difficulties), moderate (1-2 difficulties), and severe (≥3 difficulties). Main Outcomes and Measures Outpatient visits, prescription drug fills, 10 high-value services, and 12 low-value services. Results The sample comprised 188 954 adults (mean [SD] age, 48.1 [17.9] years; 101 706 females [53.8%]). Of these adults, 151 562 (80.2%) had no, 28 518 (15.0%) had moderate, and 8874 (4.6%) had severe functional disabilities. Adults with functional disabilities, especially those with severe disabilities, had a higher percentage of outpatient visits (86.2% vs 74.9%) and prescriptions filled (81.2% vs 64.2%) compared with those with no disabilities. The mean number of outpatient visits and prescription drug fills was significantly higher among those with severe vs no or moderate functional disabilities (outpatient visits: 17.5 [95% CI, 16.5-18.4] vs 8.6 [95% CI, 8.6-8.7] or 14.0 [95% CI, 13.8-14.3]; prescription drug fills: 27.8 [95% CI, 25.7-29.9] vs 10.6 [95% CI, 10.5-10.7] or 18.0 [95% CI, 17.6-18.4], respectively). Compared with adults with no functional disabilities, those with moderate and severe disabilities had higher rates of services that could be performed during an appointment, both high value (eg, adjusted differences, blood pressure measurement: 3.4 [95% CI, 2.9-3.9] percentage points and 3.6 [95% CI, 2.9-4.2] percentage points; cholesterol measurement: 3.6 [95% CI, 2.6-4.5] percentage points and 4.7 [95% CI, 3.6-5.7] percentage points, respectively) and low value (eg, adjusted differences, benzodiazepine for depression: 4.5 [95% CI, 2.5-6.4] percentage points and 8.1 [95% CI, 6.3-9.8] percentage points; opioid for back pain: 4.5 [95% CI, 3.5-5.5] percentage points and 6.7 [95% CI, 6.5-6.9] percentage points, respectively). Conversely, those with moderate and severe disabilities used fewer services that typically required a separate appointment, such as high-value cancer screenings (eg, adjusted differences, breast: −1.1 [95% CI, −1.3 to −0.9] percentage points and −9.9 [95% CI, −12.1 to −7.7] percentage points; cervical: −3.3 [95% CI, −4.9 to −1.7] percentage points and −17.3 [95% CI, −20.3 to −14.4] percentage points, respectively) and low-value cancer screenings (eg, adjusted differences, cervical: −4.9 [95% CI, −7.7 to −2.1] percentage points and −8.1 [95% CI, −12.1 to −4.0] percentage points, respectively). Conclusions and Relevance In this cross-sectional study, adults with functional disabilities used higher rates of health services than adults with no functional disabilities. However, the ease of access to services—independent of clinical value—plays an important role in utilization for those with functional disabilities.