ACCESS TO HEALTH CARE:
General Information
Access
to Reproductive Health Care
Medical Professionals’
Knowledge
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Highlights
The combined
effect of unemployment, poverty, and single marital status make women with
disabilities much less likely to have
private health insurance than non-disabled women.
· The 1994-1995
National Health Interview Survey revealed that private health insurance was
available to 47% of women with three or more limitations and 60% of women with
one or two limitations, compared to 75% of women with no limitations.
· Studies have
documented the refusal of many physicians to treat patients who do not have
private insurance, and who are covered only by Medicaid or Medicare. Thus, women with disabilities have access to
a smaller pool of physicians, who may lack experience treating women with their
disabilities.
· Inadequate capitated payment levels to health care providers create
disincentives to accepting women with disabilities and chronic conditions such
as multiple sclerosis.
More (detailed)…
Women with
disabilities who have public or private health insurance often do not have coverage for certain prescription drugs,
physical or occupational therapy, assistive devices, medical equipment, medical
supplies, or in-home attendant care services.
· These services are
denied through very restrictive definitions of medical necessity, which are
based on a health care system designed to treat short-term health conditions
rather than chronic conditions.
· Services needed to
maintain physical or mental functioning or to slow the progression of disease
or functional loss are routinely denied.
· A recent state
study consisting of 71% women found that having a chronic condition decreased the
probability of having adequate health insurance coverage by 10% and 25% if the
individual was also single. Men had a
higher probability of having adequate coverage.
· Health insurers
are legally permitted to reduce coverage for a specific chronic condition or to
raise the cost of premiums for those who have certain chronic conditions and
disabilities. In effect, this reduces
health insurance coverage for women with disabilities who cannot afford the
high premiums.
· Men and women with
disabilities and chronic conditions in managed care plans are generally less
satisfied with accessibility, technical care, communication, choice,
interpersonal relations, and quality of outcomes than those in fee for service
plans. However, managed care plans designed to address specific needs
associated with disability improve both access and outcomes compared with other
health care sources.
· Due to uncovered
health service expenses, payment of the full deductible, and having to pay
higher coinsurance costs, men and women with disabilities and chronic
conditions bear a larger burden of out-of-pocket expenses for health care than
do able-bodied persons. The greater
the number of chronic conditions, the higher the level of out-of-pocket
spending. Large out-of-pocket health
care expenses comprise a greater proportion of lower income for women, which impedes access to care, impairs health status
and quality of life, and leaves insufficient income to cover other necessities.
· Medicaid is better
than Medicare and private insurance for covering supportive services needed by
persons with functional limitations, making those with low incomes eligible for
a wider array of services than a middle-income person.
· Nearly two-thirds of
those with functional limitations who live in the community rely exclusively on
family, friends, and volunteers for personal assistance services.
More (detailed)…
Nearly 15% of
women with functional limitations in the 45-64 age range have no health care coverage at all.
· Women in this age
range are particularly vulnerable to lacking health care coverage because the
prevalence of chronic conditions begins to rise in midlife at the same time
that they are vulnerable to age-related employment discrimination or asked to
retire early, leaving them without private group health insurance, while not
being old enough to qualify for Medicare.
· Those with no health
insurance are less likely to access health care for serious symptoms than are
those with health insurance.
More (detailed)…
It is more
difficult for women with disabilities than non-disabled women to obtain needed health services from both
primary care physicians and specialists.
· Younger women with
disabilities have more difficulty obtaining general medical care, dental care,
prescription medicines, eye glasses, and mental health care than younger
non-disabled women.
· Delaying care due to cost
is a serious problem for women with disabilities, especially those in the 18-44
age range.
· A substantial proportion
of primary care physician’s offices are still not in compliance with
· Nearly a third of women
with physical disabilities reported being denied services at a doctor’s offices
solely because of their disability.
More (detailed)…
Women with disabilities
are more likely than non-disabled women to receive their usual medical care
from specialists.
· The average Medicare
beneficiary with one or more chronic conditions sees eight different
specialists.
· Due to inadequate
coordination and communications among different specialists, millions of people
with chronic conditions receive inconsistent diagnoses for the same condition
and were told by a pharmacist that a new prescription would interact with
another drug they were already taking.
· Medical
information systems do not allow physicians to know how other physicians are
treating a given patient.
More (detailed)…
Barriers to
health care have a disproportionate negative effect on the health and longevity of women with disabilities
compared to non-disabled women.
· A higher proportion
of non-survivors with compared with survivors with lupus had reported
difficulty in obtaining health care.
· Limitations and cutbacks in the
availability of in-home attendant services have a disproportionate negative
effect on women, particularly women with disabilities.
More (detailed)…
Access
to Reproductive Health Care
Women with disabilities are
significantly less likely to receive information
on contraceptive options or screening for sexually transmitted diseases
than non-disabled women.
· Studies indicate
that gynecologists are significantly less likely to ask women with three or
more functional limitations or obvious physical deformity than women with no
limitations about use of contraceptives.
·
Very
few of the women who used contraception in one study believed that their
physicians considered their disabilities when recommending a contraceptive
method.
·
Doctors who assume women with disabilities are
not sexually active may fail to screen for STDs or educate them about safe sex
practices.
·
Women with disabilities are
discouraged from getting screened for STDs by inaccessible doctors’ offices,
difficulty getting onto the examination table, or previous experience with
doctors not knowing how to handle disability-related symptoms during the exam
such as spasticity, imbalance, and autonomic dysreflexia.
·
Women with disabilities are
frequently told that a pelvic exam is unnecessary because it would be too
difficult to perform.
More (detailed)…
Women with
disabilities may be less likely to receive breast and cervical cancer
screening, are diagnosed at later stages, and experience limitations in
treatment options compared to non-disabled women.
· Women with extensive
functional limitations are less likely to receive breast and cervical cancer
screening according to recommended guidelines than non-disabled women.
· A national interview survey found that women
with major long-term mobility impairments were less likely to have Pap smears
and mammograms. The most common reason
women with disabilities give for avoiding screenings is difficulty getting
onto, or staying on, the exam table, or inability to assume the position
required for a mammogram.
· Women who are
noncompliant with mammography or cervical cancer screening are much more likely
than women who are screened regularly to have no health care plan or coverage
of preventive services, or experience other cost barriers to accessing
services.
· Women with
disabilities are more likely to be diagnosed at later stages of breast cancer.
· Treatment is
likely to be less successful when begun at a late stage, resulting in increased
mortality rates.
· There is some evidence
that women with disabilities are less likely to receive breast conserving
surgery or neoadjuvant therapy than non-disabled
women.
·
Having
certain chronic conditions and mobility impairments may limit options for
treating cancer, such as adverse outcomes from radiation or interactions of
cancer drugs with drugs taken for the chronic conditions.
More (detailed)…
Medical Professionals’ Knowledge of Women’s Health and Disability
Health care providers under any type of health care plan
generally do an inadequate job of meeting the health information needs of women with disabilities.
· Health care
provided under both fee-for-service and HMO plans did a poor job of meeting the
information needs of patients with multiple sclerosis, three-quarters of whom were women.
· Primary care
physicians and obstetricians/gynecologists generally receive very little if any
training in the effect of disability on the reproductive health of women.
· Women with
disabilities report that medical professionals often regard them as being
asexual.
More (detailed)…
Women with
disabilities from diverse ethnic
backgrounds and sexual orientation may differ greatly in their definitions
of health problems, health care seeking behaviors, and access to quality health
care.
· Lesbians often
avoid health care, or do not disclose their sexual orientation, because of
experience with negative responses from health care providers, including
inappropriate treatment, refusing to provide care, and sexual harassment.
· Gynecologists and
nurses have revealed in surveys that they do not accept lesbians and feel
uncomfortable dealing with them.
· Revealing to a doctor that
one is a lesbian may jeopardize disability and medical benefits and services.
· Disabled lesbians, especially those who are nonwhite, face
multicultural discrimination in accessing quality health care.
·
Within cultural or ethnic categories, important
differences may exist in languages, levels of acculturation based on immigrant
status, socioeconomic status, ways of understanding illness and health care,
expression and meaning of illness, differences in outcome from illness, pain
and pain coping, and psychological dysfunction in relation to stressors.
· There are racial
disparities in health care access and treatment of certain chronic conditions,
but not for others.
More (detailed)…
Interventions to Promote Quality Health Care for Women
with Disabilities
CROWD, Gynecological Concerns in the
Care of Women with Physical Disabilities
CROWD, Internet Training on
Reproductive Health Maintenance for Women with Physical Disabilities
AAMC Minimum
Competencies for Primary Care Physicians
Rehabilitation Institute of
Magee Women’s Hospital, Center for
Women with Physical Disabilities
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Highlights