(such as time-limited rentals and recycling of used equipment) and providing timely and appropriate equipment repairs; and

  • continuing research to assess and improve the appropriateness, quality, and cost-effectiveness of the assistive services and technologies provided to people with disabilities.

In addition to concerns about Medicare, the committee was concerned about the flood of changes in state Medicaid programs noted earlier in this chapter. Tracking Medicaid policies and practices is difficult, especially given the complexity of the changes directed or permitted under the Balanced Budget Act of 2003 and the Deficit Reduction Act of 2005. Analyzing the potential effects of these and other changes on people with disabilities (including changes that come with intended safeguards for this population) adds further complexity. Nonetheless, systematic tracking and analysis are important, given the particular vulnerability of Medicaid beneficiaries with disabilities—both children and adults—to reductions in coverage and increases in beneficiary (or parent) responsibilities for understanding and following complex rules.

Much research on strategies to balance access, quality, and costs has focused on care for people with high-cost chronic illnesses. These strategies include the disease management and value-based insurance strategies described earlier in this chapter and the chronic care programs discussed in Chapter 4. This research and these programs could be refined to consider more explicitly and fully the relevance and consequences of such strategies for people with various degrees of physical, mental, and cognitive impairment. The special needs plans described in Chapter 8 constitute one narrowly targeted approach, but less restrictive approaches also need to be evaluated.

This chapter and preceding chapters have suggested a number of specific topics for research. The next chapter considers more generally the organization and financing of disability and rehabilitation research. It reiterates the messages of the 1991 IOM report on disability that research in this area is underfunded and inadequately coordinated.

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