Wheelchair Funding and Ordering

Original Editor - Naomi O'Reilly as part of the Wheelchair Service Provision Content Development Project

Top Contributors - Naomi O'Reilly and Amrita Patro  

Introduction

Community participation, health and quality of life for individuals with mobility is impacted by the availability of appropriate wheeled mobility, including manual wheelchairs, powered wheelchairs, and related equipment, including cushions, backrests, and customized positioning products. Timely provision of wheelchairs, and related equipment that meets the needs of individuals with mobility limitations is key to reduce the risk of secondary complications that may result from an inappropriate wheelchair or no wheelchair. Despite this recognition of the need for timely provision access to the basic right of personal mobility outlined in Article 20 of the United National Convention for the Rights of Persons with Disabilities is often constrained at a global level by a number of factors related to funding challenges, including difficulty accessing necessary equipment. Funding has been identified by the World Health Organisation as a critical step in the wheelchair service delivery process but also been shown as a major barrier for access to wheeled mobility equipment.[1] The objective of good practice in funding and ordering is to order or procure the selected wheelchair for the user, in a timely manner to meet the needs of the individual.

Funding

Following Wheelchair Prescription when it is known what elements an individual requires in the wheelchair, the cost of the recommended product can be accurately estimated. For most services, it will be essential to ensure a funding source has been identified before an order can be placed for equipment. Funding options will vary both within and between Countries and can include funding by an out-of-pocket payment, a government subsidy, nongovernmental organization or donor agency, or a payment by an insurance company. As highlighted under the conditions of the UNCRPD and ensure these basic rights are met, it is incumbent on state entities to provide funding to cover the costs to access personal mobility equipment. [1]

Funding for wheeled mobility equipment varies hugely worldwide, ranging from coverage that is limited to specific groups, to cost-shared, or means-tested, to fully covered loan or purchase programs under health insurance or completely reliant on self-funding.

Many individuals worldwide who need a wheelchair have limited access to an appropriate wheelchair or when it is available cannot afford to buy one. Nevertheless, everyone who needs a wheelchair should have access to one, regardless of their ability to pay. Thus, funds should be made available for users who need financial assistance. Often, this responsibility lies with administrative personnel or programme managers rather than clinical or technical personnel. [2][3] Wheelchair service personnel engaging in client-centred practice often consider the costs the wheelchair users are able to bear and the funding available to them as well as the capacity of the necessary equipment and how these devices may work within their day to day lives but ultimately, ensuring devices are provided through collaboration between the wheelchair user and appropriate health professional will benefit the user, who should receive the device that best meets their needs, rather than purely a device that best meets their budget alone. [1]

According to Visagie et al (2015), lack of funding resulted in wheelchair service personnel prescribing cheaper designs, even if less appropriate than others, to increase their ability to provide wheelchairs to a greater number of users, which results with users having wheelchairs that are not appropriate and do not meet the needs the user. [4]
"It's a moral dilemma - something is better than nothing, so you end up issuing what you have available instead of what is most appropriate.’ [4]
"Restricted budget is a massive problem......" [4]
"I always think of the price before I order a wheelchair due to the budget constraints...." [4]
Visagie et al (2015) also identified that as a result of insufficient funding many wheelchair users had to wait for extremely long waiting periods, often in excess of 18 months before they would receive their wheelchair with many finding that circumstances and requirements in their wheelchair changed by the time they receive it. [4]
Patients don’t get a wheelchair at the time of prescription, and two years later they probably need something completely different...." [4]
"By the time you receive the wheelchair and issue it the prescription isn’t accurate anymore because the patient and their circumstances have changed...." [4]
Finally when we consider funding and accessing funding for wheelchair and related equipment including parts for repair we should consider the following;
  1. Eligibility
    • Wheeled mobility equipment funding should be provided to all individuals with impaired mobility regardless of age, residence, or health condition.
  1. Funding
    • Full coverage should be provided for eligible devices including standard, lightweight, or ultralightweight wheelchairs, based on assessed need.
  2. Basic or Essential Mobility. 
    • Wheeled mobility equipment should be provided to individuals for access to the home and community to promote participation and quality of life.

Ordering

The system for ordering wheelchairs will vary in different wheelchair services. When the best wheelchair for the wheelchair user has been selected and the prescription (selection) form prepared, the wheelchair needs to be ordered. [2][3]

  • If a wheelchair service keeps wheelchairs in stock, this may mean completing an order form to be authorized by the service manager. The wheelchair may then be prepared by the staff responsible for wheelchair preparation.
  • If the wheelchair service does not keep wheelchairs in stock, this may mean ordering from an external supplier.

Good Practice

Resources

References

  1. 1.0 1.1 1.2 Smith EM, Roberts L, McColl MA, Martin Ginis KA, Miller WC. National evaluation of policies governing funding for wheelchairs and scooters in Canada: Évaluation nationale des politiques régissant le financement des fauteuils roulants, des triporteurs et des quadriporteurs au Canada. Canadian journal of occupational therapy. 2018 Feb;85(1):46-57.
  2. 2.0 2.1 WHO. Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings.World Health Organization; Geneva: 2008. 
  3. 3.0 3.1 Sarah Frost, Kylie Mines, Jamie Noon, Elsje Scheffler, and Rebecca Jackson Stoeckle. Wheelchair Service Training Package - Reference Manual for Participants - Basic Level. World Health Organization, Geneva. 2012
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Visagie S, Duffield S, Unger M. Exploring the impact of wheelchair design on user function in a rural South African setting. African Journal of Disability. 2015;4(1).
  5. William Armstrong, Johan Borg, Marc Krizack, Alida Lindsley, Kylie Mines, Jon Pearlman, Kim Reisinger, Sarah Sheldon. Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings. World Health Organization; Geneva: 2008.