When we think about access to care what comes to mind are the uninsured, underinsured and those with cultural and linguistic barriers. Groups that we often don’t consider are those with disabilities.
In the case of those with physical disabilities there are inaccessible environments, e.g., ramps, facilities, equipment, communication access (a quadriplegic patient would require a voice-activated call bell). Witness the 50-year old woman with multiple sclerosis who was denied a routine mammogram because she could not stand (California HealthCare Foundation, Medi-Cal Beneficiaries with Disabilities August 2005).
In addition, there are program barriers because most programs don’t necessarily consider “special features” to assure access for people with disabilities. “The Medicaid managed care enrollment process often does not identify persons with disabilities; therefore, plans may have difficulty determining those with special health needs.” (Kaiser Commission on Medicaid Uninsured, March 2001).
Program barriers can take the shape of long waits, long travel times and language barriers. It was also found that “sizeable minorities of SSI* beneficiaries …are not receiving basic preventative care – an annual dental visit, a flu shot and, for females, a Pap smear.” (Access to care among disabled adults on Medicaid, Health Care Financing Review Summer 2002). In a time when the concern is “outcomes”, it must be acknowledged that there is unmet need and often, as with many without disabilities, the disabled default to the ER to meet their need.
When we think of “access to care”, we usually think of not having health insurance, racial/socio-economic differences in access to providers, and even differences in quality. According to JAMA, “Although the ADA and its regulations create an important foundation of basic requirements for accessibility, its provisions are insufficient for making health care facilities comfortable and safe for individuals with disabilities.” (JAMA, Structural Impairments That Limit Access to Health Care for Patients With Disabilities, JAMA, March 14, 2007).
Medicare provides coverage for 6 million people who are disabled and younger than 65 (Kaiser Family Foundation). In 1998, 1.6 million non-elderly persons with disabilities were enrolled in Medicaid managed care, representing 12% of total Medicaid managed care enrollment. (Kaiser Commission on Medicaid Uninsured, March 2001). This is a burgeoning percentage of the U. S. patient population that can comment on patient satisfaction of access to care.
Despite the regulatory mandates of the ADA concerning accessibility to buildings and facilities, we don’t think about “access” meaning not being able to receive a quality chest x-ray or mammogram.
* SSI: Supplemental Security Income (SSI) is a Federal income supplement program funded by general tax revenues (not Social Security taxes). It is designed to help aged, blind and disabled people, who have little or no income; it provides cash to meet basic needs for food, clothing and shelter. (Social Security Online)
California HealthCare Foundation, Medi-Cal Beneficiaries with Disabilities August 2005.
Kaiser Commission on Medicaid Uninsured, March 2001.
Access to care among disabled adults on Medicaid, Health Care Financing Review Summer 2002.
About the Author
Dr. Flippin brings a wealth of experience, starting with her long tenure as an attending physician at the Cook County Hospital Emergency Department. She is currently Corporate Compliance and HIPAA Privacy Officer at major Chicago hospital.