Review and assessment of policies and practices for spinal cord injury-related health care supplies, services, and mobility equipment reveal wide inequities and inadequacies in Canada

Introduction: Canada maintains a universal, publicly funded health care system, although provinces and territories retain flexibility and independence in determining eligibility and funding levels for services and supplies. This flexibility and independence can lead to variability in health care delivery and therefore downstream health outcomes between provinces for the same health condition. Over 80,000 Canadians live with spinal cord injury (SCI), which causes motor paralysis and dysfunctions in multiple body systems. These dysfunctions are managed as multiple chronic health conditions to maintain life after injury. Thus, we identified whether and how a critical subset of health services, supplies, and equipment needed to sustain life after SCI are delivered at the provincial and federal levels for: attendant services for activities of daily living, medical supplies to manage neurogenic bladder and bowel function, and manual and power wheelchairs (WCs). Methods: A scoping policy review of online documentation identified eligibility criteria, assessment processes, coverage characteristics, quality and quantity limitations, delivery mechanisms, and any quality assurance processes. Key informant (KI) interviews were analyzed descriptively and thematically to verify policy documentation and identify additional documentation when needed, and to indicate gaps between policy and application. Results: Widespread discrepancies and inadequacies were found in the quality and level of SCI-related health care. Policies indicated means-testing for attendant services in 5/10 provinces; 9/10 for bladder and bowel supplies; and 4/10 for WCs. Public funding is often reduced or withdrawn at very low incomes. Provinces without means-testing loan WCs from restricted equipment pools. KI interviews indicated profound negative implications of stated inadequacies on health and life quality. National programs for Veterans and Indigenous Canadians do not means-test, but eligibility and service restrictions were reported to confer additional hardships on Indigenous Canadians. Discussion: In contrast to other forms of care (e.g., dialysis for kidney disease), SCI-related health care appears inadequate, highly variable, and focused upon social and financial factors rather than medical need. For those with SCI, age restrictions further limit access to health care. Future research of countries with similar decentralized, multiregional health care systems would aid in developing national standards and best practice delivery mechanisms.