ing arrangement developed by the Center for Assistive Technology at the University of Pittsburgh Medical Center (UPMC) in conjunction with the UPMC Health Plan, a manufacturer of costly power wheelchairs, and a local network of suppliers (Schmeler et al., 2003). The program is specifically designed to make the equipment quickly available to people with rapidly advancing health conditions (e.g., amyotrophic lateral sclerosis) whose use of the equipment may be limited to a period of months. Rather than the Health Plan purchasing a $25,000 power wheelchair for a consumer, the chair can be leased on a monthly basis for a reasonable fee. The fee includes the provision of all maintenance and upgrades as the person’s condition changes. Once that person no longer uses the equipment, it is recycled and re-leased. With the program, people with these conditions have access to equipment much sooner and the health plan claims significant cost savings. The suppliers and the manufacturer do not consider the program to have interfered with their profit objectives because the equipment can be leased repeatedly over several years.

A particularly weak point in the chain of effective technology use is coverage for maintaining, repairing, and replacing an assistive technology when necessary. Some users may have the knowledge and physical abilities to repair simple products, but expert assistance will often be required, especially for complex and expensive equipment. In addition, when an effective product is prescribed and is then used and wears out, people often find that their insurance does not provide for replacement or does not provide for replacement frequently enough. Chapter 9 recommends revisions in health plan policies to increase access to assistive technologies and support their maintenance, replacement, and repair.

Although the committee did not locate specific documentation, committee members working in rehabilitation reported decreasing numbers of assistive technology clinics and programs within hospitals and reductions in the scope of programs related to reduced rates of reimbursement and other onerous provider payment policies. (See footnote 2 in Chapter 9 on the controversy about restrictions on reimbursements to inpatient rehabilitation facilities.) An analysis of the complex issues of payment for rehabilitation services was beyond the committee’s resources. Still, without mechanisms in place to fit equipment and adapt or train individuals in its proper use, even a potentially very effective assistive technology can fail.

Through the Consumer’s Eyes

One challenge for health care professionals, family members, and others who may be involved in discussions of assistive technologies is to consider outcomes “through the consumer’s eyes” (see, e.g., Taugher [2004] and Lilja et al. [2003]). Each of these parties may have priorities different

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