Medicare expanded its policy for clean intermittent catheterization in April 2008, covering up to 200 single-use catheters in addition to the previous monthly maximum of 4. The policy shift was driven by the belief that using disposable catheters will reduce the likelihood of contracting a urinary tract infection UTI. 

Researchers assessed the policy’s effects in a prospective spinal cord injury registry because of its economic and environmental consequences (∼50-fold increase in cost and plastic waste) and a lack of supporting evidence. From 1995 to 2020, investigators looked at 1-year follow-up information for those who suffered spinal cord injuries and were unable to avoid it of their own volition. They aimed to find out if there was a reduction in genitourinary-related hospitalizations and if there was an increase in the use of clean intermittent catheterization due to the policy shift. In the study, 2,657 (38.8%) of the 6,843 people who could not empty on their own after spinal cord damage was admitted to the hospital within the first year after the injury. 

Multivariate logistic model (odds ratio, 0.67, P<.001) confirmed that fewer people in the cohort undergoing clean intermittent catheterization were hospitalized for genitourinary causes before the policy change than after. Fewer people at the 1-year follow-up also performed clean intermittent catheterization after the policy shift (57.0% vs. 59.1%, P=.044). According to their research, the policy change in 2008 that reduced coverage for reusable catheters and increased coverage for single-use catheters for people with spinal cord injuries did not reduce the number of hospitalizations for urinary tract infections or increase the use of clean intermittent catheterization.