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Article Excerpt
Individuals with disabilities tend to have more health care access problems, have secondary health conditions, have unmet health care needs, and are less likely to be satisfied with medical care than those without disabilities (Batavia, 1995; Hagglund, Clark, Conforti, & Shigaki, 1999). With nearly 20% of the US population with one or more disabilities, there is a great need to address the barriers that prevent this population from accessing the health care services, such as physician services, that they require (US Bureau of Census, 2006).
Scheer, Kroll, Neri and Beatty (2003) defined three broad categories of barriers to health care services: environmental, structural, and process. Environmental barriers include issues of office accessibility, such as parking, entry, restrooms, waiting rooms, examination rooms, and diagnostic equipment. Physician's offices have been noted to lack equipment and space essential for treatment of patients using wheelchairs. Many offices are without adequate room to maneuver a wheelchair, use examination tables that are too high, and do not have sit-in scales (DeJong, 1997). Transportation barriers such as the lack of access to public transportation, publicly funded door-to door transportation, and taxicab services, also have an effect on the perceived accessibility of health care services (Scheer et al., 2003). Structural barriers refer to a lack of financial resources for necessary services. Process barriers relate to the delivery of service. For example, lack of provider knowledge and lack of timeliness of service are issues frequently reported by patients. Provider attitudes have also been cited as a barrier to accessing services (Au & Man, 2006)
Cost as a Barrier to Health Care Access
Addressing structural barriers specifically, Sheer and colleagues (2003) argue that limited health benefit programs, whether publicly or privately funded, may not provide for services such as physical and occupational therapy, high quality and well-fitted functional durable medical equipment, and mental health services. In addition, a considerable proportion of people with disabilities report serious problems accessing prescription drugs (32%), dental care (29%), equipment (21%), mental health services (17%), and home care (16%) due to cost (Kennedy & Erb, 2002; Schultz, Shenkin, & Horowitz, 1998).
Barriers to Physician Services for Women with Disabilities
There is a limited but growing body of research focused on health care disparities faced by women with disabilities. According to a study by Parish and Huh (2006), women with disabilities experience poorer health and preventive care than women without disabilities. Results of this study revealed that 19 percent of women with disabilities postponed such care compared with the 8 percent of women without disabilities. Additionally, 20 percent of women with disabilities postponed getting needed medications compared to 6 percent of women without disabilities A study by Parish and Ellison-Martin (2007) examined a national sample of low-income female Medicaid recipients and found that despite having similar potential for care (i.e., health insurance, usual source of care, and having a physician as a usual source of care) compared to women without disabilities, women with disabilities had substantially worse rates of receiving medical care and medication when they were needed. In a study utilizing a national publicly available dataset, Smith (2008) found that women with disabilities had less access to health care than women without disabilities and men with disabilities. Chevarley, Theirry, Gill, Ryerson, and Nosek (2006) found that women with three or more functional limitations were more likely to report being unable to get general medical care, dental care, prescription medicines, or eyeglasses compared to women without functional limitations. The primary reason cited for being unable to receive general care were financial problems or limitations in insurance.
Equity of Access
When discussing barriers to accessing health services, especially for vulnerable populations such as persons with disabilities, the issue of equity of access should be considered. According to Aday (1975), equity of access is best considered in the context of whether people actually in need of medical care receive it or not. However, as Anderson (1978) points out, the importance of equity of access carries with it the implicit assumption that medical care is related to the quality of personal health and therefore differential health levels are a valid consideration in evaluating how health services should be distributed. Equity of access is an important consideration for this population as previous studies have indicated that persons with disabilities and specifically women with disabilities who may be most in need of health care services may not be receiving services commensurate to the level of their need.
The purpose of this study was to specifically examine disparities in access to physician services due to cost for women with disabilities using the 2005 Behavioral Risk Factor Surveillance System (BRFSS). It was anticipated that our study will add to the existing body of research by using a nationally representative data set (with age-adjusted findings) examining a broad range of variables for women with disabilities in comparison to both men with disabilities and women without disabilities. The research questions asked were: (1) is there a difference in reported inability to see a physician due to cost between women with and...
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