Implications of prosthesis funding structures on the use of prostheses: experiences of individuals with upper limb absence.

摘要

BACKGROUND: While sparsely researched, funding structures may play an important role in use of and satisfaction with prostheses and related health services. OBJECTIVES: The objectives of this study were to (1) quantify the direct costs of prosthesis wear, (2) explore variations in funding distribution, and (3) describe the role of affordability in prosthesis selection and wear. STUDY DESIGN: An anonymous, online cross-sectional descriptive survey was administered. METHODS: Analyses were conducted of qualitative and quantitative data extracted from an international sample of 242 individuals with upper limb absence. RESULTS: Access to prosthesis funding was variable and fluctuated with age, level of limb absence and country of care. Of individuals who gave details on prosthetic costs, 63% (n = 69) were fully reimbursed for their prosthetic expenses, while 37% (n = 40) were financially disadvantaged by the cost of components (mean [SD] USDollars 9,574 [Dollars 9,986]) and their ongoing maintenance (USDollars 1,936 [Dollars 3,179]). Of the 71 non-wearers in this study, 48% considered cost an influential factor in their decision not to adopt prosthesis use. CONCLUSIONS: Prosthesis funding is neither homogeneous nor transparent and can be influential in both the selection and use of a prosthetic device. CLINICAL RELEVANCE: Inequitable access to prosthesis funding is evident in industrialized nations and may lead to prosthesis abandonment and/or diminished quality of life for individuals with upper limb absences. Increased efforts are required to ensure equitable access to upper limb prosthetics and related services in line with individuals' needs.