Health Care Disparities
Access to quality medical care, when and as often as needed, is critical for maintaining good health and functioning, detecting and intervening early for potential health problems, and addressing acute health concerns. For people with disabilities who experience a “thinner margin of health” (Pitetti & Campbell, 1991), access to primary health care is particularly important for maintaining good health and functioning. Yet people with disabilities report having more unmet health care needs (NOD/Harris, 2004) and receiving fewer services for routine health care and preventive services than the general population (Chan, Doctor, MacLehose, Lawson, Rosenblatt, Baldwin, 1999; Diab & Johnson, 2004; Drum, 2003; Drum, Horner-Johnson, Krahn, & Culley, 2002; Hagglund, Clark, Conforti, & Shigaki, 1999; Iezzoni, McCarthy, Davis, & Siebens, 2000; NOD/Harris, 2004). For example, data from the 1994 National Health Interview Survey Disability Supplement showed that working-age people with mobility limitations experienced far lower rates of health services such as blood pressure checks, cholesterol screening, mammography, and far lower rates of health behavior counseling around issues related to alcohol and substance abuse, diet and eating habits, regular physical exercise, and smoking cessation (Jones & Beatty, 2002). More recent data from a national survey of adult primary care providers identified physician-reported differences in the care of patients with and without disabilities. Physicians provided decreased attention to a number of preventive care services (i.e., blood pressure, cholesterol, colorectal screens, mammograms) and less counseling on high-risk behaviors (i.e., smoking, exercise, stress) for their adult patients with physical disabilities (RRTC: Health and Wellness, 2003).
Two state-population database linkage studies demonstrate other dimensions of inequitable access to health care. Individuals with disability-eligible Medicaid codes are slightly over-represented in the cancer registry for smoking-related cancers, and women with mobility and/or cognitive impairments are at increased risk of having their cancers detected at later stages (Austin, 2003). A second population data-base study documented that adults with disability Medicaid codes participated in publicly sponsored drug and alcohol treatment at only one-half the rate of other Medicaid subpopulations (Krahn, Deck, Gabriel, & Bersani, 2004), despite other studies suggesting substance abuse rates that are equal to or higher than the general population (Hubbard, Everett, & Khan, 1996; Moore, Greer, & Li, 1994).
Health differences between people with and without disabilities appear unrelated to insurance coverage, since people with disabilities are as likely to have insurance as the general population (NOD/Harris, 2004). Rather they appear to be more systemic in terms of health care provider behaviors, clinic site and medical equipment inaccessibility, transportation difficulties, inaccessible fitness facilities, and availability and accessibility of health information for persons with disabilities (Cardinal & Spaziani, 2003; Downs, Wile, Krahn, & Turner, 2004; O’Day, Dautel & Scheer, 2002).