A narrow interpretation of “medical necessity” can result in poorer health as well as a more restricted life for people with disabilities. We examined the impact of US policy on reimbursement of intermittent catheters (ICs) on the lives of people with neurogenic bladder (NB) who require catheters to urinate. We conducted in-depth, longitudinal interviews with nine stakeholders. Actor-Network Theory was used to describe interactions among human agents, IC products, and policies in the reimbursement arena. Restrictions on the type and quantities of ICs reimbursed emerged as the most potent inhibitor to health and wellbeing among consumers with NB. IC suppliers, due to the large number of other stakeholders with whom they interact in the reimbursement process, emerged as strong enablers of preferred IC use among people with NB. Lack of an impartial central clearinghouse on IC products and coverage impeded consumers’ ability to make informed decisions.


actor-network theory, interpretative phenomenological analysis, disability-competent care, intermittent urinary catheter, neurogenic bladder, reimbursement, spina bifida, spinal cord injury

Author Bio(s)

Manon Maitland Schladen, PhD is a senior research associate at MedStar Health Research Institute and assistant professor of rehabilitation medicine at the Georgetown University Medical Center. Please direct correspondence to mmschladen@gmail.com.

Amanda K. Rounds, PhD, is a clinical research coordinator at MedStar Health Research Institute. Please direct correspondence to amanda.k.rounds@medstar.net.

Terrence McManus, ANP, serves as a consumer expert for MedStar Health Research Institute. He is an individual living with spinal cord injury. Please direct correspondence to terryinkosovo@yahoo.com.

Alexandra Bennewith is vice president of government relations at United Spinal Association. Please direct correspondence to ABennewith@unitedspinal.org.

Henry Claypool is policy director for the Community Living Policy Center at the University of California, San Francisco. He is an individual living with spinal cord injury. Please direct correspondence to hdc1819@gmail.com.

Suzanne L. Groah, MD, is director of the Spinal Cord Injury (SCI) Research program at MedStar National Rehabilitation Hospital, and professor of Rehabilitation Medicine at the Georgetown University Medical Center. Please direct correspondence to suzanne.l.groah@medstar.net.


Authors express their appreciation to Elizabeth F. Davis, consumer expert (spinal bifida) at MedStar Health Research Institute, for her help in the design of the interview guide, conduct of semi-structured interviews, open coding, and editing of the manuscript.

Publication Date


Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 International License.







To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.