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Users of wheelchairs and scooters include people who are unable to walk, or who have difficulty walking due to neurological dysfunction or muscular weakness. Individuals who might be likely users include those with spinal cord injuries (SCI), hemiplegia, and other types of paralysis, multiple sclerosis (MS), cerebral palsy (CP), amyotrophic lateral sclerosis (ALS), spina bifida, arthritis, and lower limb amputees (Figure 1). Jones & Sanford2 (1996) reported that there were 1,363,026 manual wheelchair users in the United States. In addition, there were 93,467 power wheelchair users. This totals 1,459,493 wheelchair users in the USA alone, which is the equivalent of 38% (Figure 2) of equipment purchases for the entire home medical market. The scooter market is smaller than wheelchairs. According to Jones & Sanford4 (1996), there are 63,636 scooter users in the United States. Typical users of power scooters include individuals in need of mobility assistance outside of the home, in particular for traveling long distances. This condition can be temporary, permanent and stable, or permanent and progressive.
Figure 1: Disability in the United States: Prevalence and Causes, 1992 (LaPlante 1995) 1
Figure 2: Market share of the home medical market by major category. PRODUCT CLASSIFICATIONS Medicare, Medicaid, Department of Veterans Affairs and insurance companies consider wheelchairs and scooters as Durable Medical Equipment (DME). Reimbursement is provided depending upon whether it is a manual wheelchair base, a power wheelchair base, or wheelchair options and accessories. Durable Medical Equipment consists of items - usually "hardware" - that is used at home (Duff, 19975). It must be able to stand up to repeat use, used in the home environment, and be medically useful (that is, its first use must be medical, something a healthy person wouldn't ordinarily need). Medicare and other health care insurance companies classify scooters for reimbursement as a power operated vehicle (P.O.V.). A) Manual Wheelchairs The key functional ability needed to use a manual wheelchair is the use of at least one arm. According to reports from Medicare (Health Care Financing Administration, Office of Information Services), the major reimbursement party for both manual and power wheelchairs, manual wheelchairs are one of the top 20 reimbursed products in the USA. Medicare expenditures over a three-year period for a manual wheelchair grew at a steady rate from $95 million in 1995, to $97 million in 1996, to $103 million in 1997. B) Power Wheelchairs The key functional ability that is required to use a powered wheelchair is voluntary control over some body function that can be utilized to control switch technology when maneuvering the chair. Medicare7 sources showed a three-year growth rate starting at $24 million in 1995, $64 million in 1996, and $140 million by 1997. C) Wheelchair Options & Accessories Wheelchair accessories and options are considered any modifications or additions made to an existing wheelchair due to medical necessity or recreational purposes and are not sold as part of the original chair. Options and accessories can include the following items: arm, back, foot and leg rests; specialty seats; hand rims; rear wheels and wheel locks; batteries/chargers and parts for motorized/powered chairs; misc. accessories, such as cup holders, tote bags, and umbrellas. While all are optional, reimbursement for coverage will depend on the item as well as the individual's needs. D) Scooters Scooter operation requires the use of at least one arm (for steering and controlling the speed), trunk control for sitting and balance, and the ability to transfer into/out of it. "The USA scooter market is expected to grow from $129.6 million in 1997 to $154.4 million in 2001 according to analysts Frost & Sullivan." 8. REIMBURSEMENT When purchasing Durable Medical Equipment, such as manual and power wheelchairs, there are several avenues for reimbursement consumers can consider, both public and private. These options include Medicare, the major reimbursement source (Figure 3), as well as, Medicaid, the Veterans Administration, private insurance, workers' compensation, and community service groups (for example, Lions, Kiwanis, and so on). Figure 3: Expenditures in the wheelchair market according to
methods of payment: It should be noted that, private insurance normally takes precedence over any government sponsored programs. In these situations the secondary payer, for example, Medicare, will pay the remaining balance if the primary payer does not cover the full amount, or, if the claim is refused by the primary payer: providing the claimant qualifies for Medicare coverage in the first place9. According to the US Census Bureau11, 162 million Americans were covered by private insurance related to employment of self or by family members. During the same study period (results gathered from 1987 to 1995), the number of people on Medicaid coverage was 34 million, and those with Medicaid coverage was 32 million. There were approximately 41 million people reporting no health coverage of any type. Since scooter users may have some ability to walk scooters are often deemed leisure or recreational items and not medical necessities, and are therefore not reimbursable by some insurance companies or programs. However, the difference in acceptance may be as simple as the doctor stating that the scooter is required for use indoors and outdoors -- thereby justifying a medical necessity. A summary of the major funding sources, including information on the legal basis, eligibility requirements, and payment policy can be found in Figure 4. Specific reimbursement rates are not included in this report due to the individual requirements of each wheelchair prescribed, in particular wheelchair prices and coverage of powered chairs. Most reimbursement agencies responded the coverage was heavily dependent upon the ability to prove "medical necessity". According to Medicare , it requires a physician's prescription for DME. Also required is supporting documentation, called a certificate of medical necessity that identifies the client's diagnosis, prognosis, the reason that the equipment is required and an estimate from the doctor on the duration that the equipment will be used. Figure 4: Overview of Key Funding Sources for Wheelchairs & Scooters
REFERENCES 1 LaPlante, M.P., & Carlson, D. (1995). Disability in the United States: Prevalence and Causes, 1992. San Francisco, CA: National Institute on Disability and Rehabilitation Research. 2 Jones, M. L., & Sanford, J.A. (1996). People with Mobility Impairments in the United States Today and in 2010. Assistive Technology, 8 (1), p. 43-53. 3 Schworm, Kimberly (1998). The Industry's Facts & Figures. HomeCare Magazine, 20(7), p. 51-58. 4 Jones, M. L., & Sanford, J.A. (1996). People with Mobility Impairments in the United States Today and in 2010. Assistive Technology, 8 (1), 43-53. 5 Duff, S. (Ed.). (1997). Home Medical Equipment Answer Book. Rockville, MD: United Communications Group. 6 Schworm, Kimberly (1998). The Industry's Facts & Figures. HomeCare Magazine, 20(7), p. 51-58. 7 Schworm, Kimberly (1998). The Industry's Facts & Figures. HomeCare Magazine, 20(7), p. 51-58. 8 Luderer, M. (1998). Shifting Into High Gear; Innovation and Need Drive American and European Scooter Markets. Home Care. Magazine, 20(4) p. 80-81. 9 Duff, S. (Ed.). (1997). Home Medical Equipment Answer Book. Rockville, MD: United Communications Group. 10 Schworm, Kimberly (1998). The Industry's Facts & Figures. HomeCare Magazine, 20(7), p. 51-58. 11 U.S. Census Bureau of the Census; "Health Insurance Coverage: 1995 - Table B;" September, 1996 12 CCH Incorporated, Medicare Explained, 1996, p 98 - 102. [ Top of Page ] |
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