The Disparities in Healthcare in People with Disabilities

One of the biggest health concerns today includes people with disabilities and their unmet needs of health care. According to the World Health Organization (WHO), there are over a billion people who are defined as disabled. Yet a recent survey of people with mental health disorders showed that 35-50% in developed countries and 76-85% in developing countries received no treatment in the year before the study. This means that several hundreds of millions of people with disabilities are not being treated in a timely manner leading to worsening conditions. The barriers to accessing health care include cost, limited health services geared towards the disabled, physical barriers, and lack of knowledge and skills from providers among other things like stigmatized views towards the disabled.

Among the barriers to health care for people with disabilities include the discrimination and disparity of health care provided. In a qualitative study done in England pertaining to people with intellectual disability, it was found that patients were treated unfairly with negative staff attitudes and behavior “including questioning whether the person was worthy of surgical treatment, due to discriminatory judgments about the person's quality of life (1).” In addition, general practitioners did not include these patients in their consultations, did not review their medications, did not conduct blood tests, did not conduct health reviews, and did not promote health screenings. All of these discriminatory acts led to subpar health care received in addition to diagnostic overshadowing when providers misattributed physical and mental health problems to a patient’s disability. Overall, the study found six themes leading to the barriers in health care access for people with disabilities: 1) Problems with communication 2) Problems with accessing help 3) Problems with how health professionals relate to care-takers 4) Complexity of the healthcare system and lack of support for care-takers 5) Substandard care of people with intellectual disability and 6) Problem with staff attitudes, knowledge and behavior.

One of the biggest themes leading to the subpar care in my opinion is the problem with staff attitudes, knowledge and behavior as it leads to other major problems like communication, accessing help, and how providers relate to care-takers. First off, providers did not modify their care to the needs of the patient. Patients complained that providers asked too many questions, spoke quickly, ignored them by talking with their parents or care-takers, or did not give them enough time to respond. In some cases, patients and their care-takers were not informed before given medications or procedures. One patient stated that their legs were put in stirrups and then given an epidural without any prior notice. Acts like this lead to patients frequently missing their next appointments as they feel bullied and forced by their providers. In addition, providers did not convey to patients or their care-takers specialist services or child-to-adult transition services that should have been provided to patients with disabilities leading to several patients falling through the gap and no longer receiving health care. Even worse was when providers did not share information or consult the patient or their care-taker on clinical decisions. Clinic letters were not received by some care-takers and so they either had to attend all appointments or not know what was done at clinic. Patients and care-takers were unable to complain about these circumstances as they either did not know how to make an official complaint, did not think it would make a difference, or were worried that complaining would make the inadequate care they currently received even worse in the future.

Despite all the negative experiences of people with disabilities, there were some who did have good experiences with receiving care. Examples of good practice included staff that accommodated the needs of patients and were respectful to both the patient and care-taker. They were friendly and helpful and providers listened to the patient directly. Health systems were flexible and extended appointment times for patients with intellectual disabilities so that patients and their care-takers would have more time to convey their thoughts and get a good grasp on the care plan. In addition, general practitioners and staff provided health check-ups, good child to adult transition of care services, good continuity of care, and support for care-takers as well. All of this shows that a positive change in attitudes of the staff can lead to better patient health care and satisfaction.
care they currently received even worse in the future.

Despite the study pertaining to people with intellectual disabilities, I believe these themes can be generalized to other people with disabilities as well. However, there is still a long way to improving access to health care for patients with disabilities. Some strategies to improve include better financing and making health care affordable, passing more policies and legislation in favor of equal care, and simple things like making information provided to patients and care-takers easier to read.

References:
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741324/
2. https://www.who.int/news-room/fact-sheets/detail/disability-and-health
3. https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services