OBJECTIVES : Intermittent catheterization (IC) is a bladder emptying technique used in conditions where an individual requires either short term or lifelong catheter-based management of the urinary bladder. As there have been myriad changes in the healthcare sector regarding benefits and coverage, it is of interest to understand how the amount of insurance coverage of IC supplies (full, partial, none) is associated with IC practice, namely, type of intermittent catheters used, reuse of catheters, and UTI management.

METHODS : A cross-sectional self-reported survey of individuals who use intermittent catheterization residing in the United States was conducted in 2017 and 2018; individuals recruited from United Spinal Association. We analyzed a subset of this survey consisting of 366 individuals.

RESULTS : Two-thirds of the respondents are male, average cohort age of 53.1 years (range 18-80+), and 85% have been practicing IC for longer than two years. Forty-seven percent of the respondents report complete insurance coverage (no out of pocket costs) for their IC supplies, 40% partial coverage, and 13% no coverage (completely paid out of pocket). Of the respondents with no coverage, 94% use non-lubricated catheters, 55% reuse their catheters, and 51% attempt to self-manage their UTIs. Contrast this to respondents with full coverage in which, 42% use non-lubricated catheters, 8% reuse, and 21% self-manage. The percentage distribution for respondents with partial coverage was in between those of no coverage and full coverage (i.e. 59%, 15%, and 27%).

CONCLUSIONS : This study finds that as insurance coverage amount decreases, there is an associated increase in non-lubricated catheter usage, reuse of catheters, and individuals who use intermittent catheterization are more likely to self-manage their UTIs. These findings suggest that lack of health care coverage affects IC practice behavior with the potential for negative health outcomes for individuals who use IC.