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Access to Healthcare for Women with Disabilities

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Access to quality healthcare is important for preventing and managing disease and maintaining overall health. Access is defined as the extent to which people can get necessary health services to achieve their optimal health.1

People with disabilities often face several barriers when accessing healthcare. These barriers are often greater for people with disabilities living in rural areas. Multiple factors have been recognized as barriers to accessing quality healthcare, such as lack of transportation, lack of specialized care locally, limits in insurance coverage, and lack of financial resources.2 Due to the limited access to quality healthcare, there can be delays in receiving care and even failure to receive needed care at all.2

Access in Medical Settings

Accessibility in medical settings is vital to providing healthcare. The Americans with Disabilities Act of 1990 (ADA),3 Section 504 of the Rehabilitation Act of 1973,4 and the Patient Protection and Affordable Care Act of 2010,5 require providers to make their facilities and services accessible to all people with disabilities.6

Women with disabilities are less likely to have access to healthcare when compared to women without disabilities.7 As a result, they may report poor health and are at greater risk for additional health conditions.8

Women with disabilities still face barriers to getting basic healthcare, even when they have insurance or live near health services. Such barriers may include:9

  • Providers’ negative attitudes toward disability
  • Providers’ lack of knowledge and understanding of disability
  • Health information not available in an accessible format
  • Lack of accessible medical equipment, such as exam tables that lower and raise for transfers
  •  Limited) time for exams or procedures
  • Low income or poverty
  • Lack of health insurance
  • Lack of transportation
  • Lack of accessible communication; for example, no interpreters for people with hearing impairments

Helpful Tips to Help Minimize the Barriers

  • Be proactive
  • Call ahead to the healthcare provider to ensure materials will be in an accessible format
  • When making appointment be sure to let the receptionist know you will need a room with an accessible table and if you will need additional assistance such as a Hoyer lift or a nurse to help with transfers
  • Advocate for yourself
  • Bring someone you trust to your healthcare appointment so they can help take notes
  • Call ahead to the healthcare facility to ask about the nearest accessible parking

Finding a Healthcare Provider

Finding an effective healthcare provider can be challenging. It is important to remember when looking for a provider to find one who is going to meet a person’s individual needs. In other words, just because a friend or family member recommends a provider does not necessarily mean they are going to be a “good fit” for the person’s needs. A good healthcare provider should encompass four main concepts:10

  1. A partnership with the patient which encompasses respect for what the patient needs and wants. The patient has the support and the materials needed to participate in the decisions of their care.
  2. A healthcare provider who is accountable for the patient’s physical and mental healthcare needs will offer resources and referrals to other healthcare providers as needed.
  3. A provider’s facilities should be universally accessible to all patients.
  4. A healthcare provider who is committed to quality and safely ensures their patients can make informed decisions regarding their health.
     

Women with disabilities may face difficulties finding a provider who understands their particular disability.11 Therefore, it is important to know exactly what one is looking for in a healthcare provider and have questions prepared in advance when scheduling an appointment or meeting the provider in person. The following suggestions may help women with disabilities identify a healthcare provider that meets their needs and avoid any accessibility issues when arriving at the healthcare facility.

  • Prepare a list of questions to ask medical offices about accessibility. For example, one could ask about parking, entry doorways, elevators, waiting rooms, patient information forms, medical/exam equipment, and restroom accessibility.
  • Search for information online to learn more about the providers and facilities.
  • Ask for suggestions for healthcare providers from other women with disabilities.
  • Ask if the health provider accepts your specific insurance or if they allow payment plans.

Preparing for an Office Visit

Getting ready for an appointment with a healthcare provider involves much more than arranging transportation, whether going for a first-time office visit or a follow-up. There are factors that can make preparing for an office visit go more smoothly. If this is a woman's first visit with a healthcare provider, it can be treated much like an “interview.” This is where the woman can ask questions, such as “Have you ever treated another patient with my disability?”, “What knowledge do you have about my specific disability?” The woman can then decide whether she feels the healthcare provider has a good bedside manner, if she can communicate openly with the provider, if the provider listens to her, and if there is a sense of good rapport and mutual trust.10

What to Bring to Your Healthcare Appointment

  • Insurance card
  • Knowledge of your family health history
  • A list of your medications
  • A list of topics you would like to discuss
  • A friend, family member, or care attendant if you feel comfortable and you want someone else there to help take notes and listen to what the healthcare provider has to say

Access to Reproductive Healthcare

Women with disabilities need and have the right to access the same reproductive care as women without disabilities.12 Optimal reproductive health demands equal access to inclusive, competent, and medically appropriate reproductive health services and information. For further information, follow these links for important aspects of women’s reproductive health: contraception, pregnancy and childbirth, and the well woman exam.

Preventive Services

Preventive care is an important way to reduce or prevent the risk of medical problems or diseases. Women with disabilities are at high risk for chronic disease.15 Risk factors for many chronic diseases are modifiable (or can be changed). Examples of modifiable risk factors include poor diet, tobacco use, and lack of physical inactivity.

Making healthy choices and visiting the doctor regularly for preventive services can help prevent chronic diseases. Examples of women’s preventive health services include cervical cancer screenings, mammograms, and prenatal care. Unfortunately, women with disabilities are less likely than women without disabilities to receive preventive healthcare and screenings.16

To help women and other people with disabilities receive necessary preventive health services, the healthcare system should be more responsive and proactive.17 It is also important for women with disabilities to advocate for their health screenings and other preventive healthcare.

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Resources

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Agency for Healthcare Research and Quality. (2016, May). Access and disparities in access to health care. Accessed December 21, 2021.

American College of obstetricians and gynecologists. (2021). Making the most of your health care. Accessed December 21, 2021.

Centers for Disease Control and Prevention (2020, September 16). Common barriers to participation experienced by people with disabilities. Policy Accessed December 21, 2021.

National Institute on Health. (2020, November 29). Clear Communication: Talking to your doctor or healthcare provider. Accessed December 21, 2021.

Gilmer T. Equal Health Care: If Not Now, When? In. New Mobility. New York, NY: United Spinal Association 2013.

Healthy People. (2021, December 27). Access to health care. Accessed December 21, 2021.

American Heart Association. (2018, January 31). Preparing for Medical Visits. Accessed December 21, 2021.

National Institute on Health. (2020, February 3). Talking with your doctor – How to prepare for   a doctor’s appointment. Accessed December 21, 2021.

Patient Empowerment Network. (2016, December 27). 15 tips to get the most from your doctor’s visit. Accessed December 21, 2021.

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References

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  1. Institute of Medicine (US) Committee on Monitoring Access to Personal Health Care Services. Access to Health Care in America. Washington (DC): National Academies Press (US); 1993.
  2. Davidsson N, Södergård B. Access to Healthcare among People with Physical Disabilities in Rural Louisiana. Soc Work Public Health. 2016;31(3):188-95. doi: 10.1080/19371918.2015.1099496.
  3. Department of Justice Civil Rights Division. Americans with Disabilities Act of 1990, As Amended. Accessed December 21, 2021.
  4. U. S. Department of Labor. Section 504, Rehabilitation Act of 1973. Accessed December 21, 2021.
  5. Healthcare.Gov. Read the Affordable Care Act. Accessed December 21, 2021.
  6. US Department of Justice Civil Rights Division Disability Rights Section and US Department of Health and Human Services Office for Civil Rights. American with Disabilities Act, Access to Medical Care for Individuals with Mobility Disabilities. 2010.
  7. Smith DL. Disparities in health care access for women with disabilities in the United States from the 2006 National Health Interview Survey. Disabil Health J. 2008;1(2):79-88.
  8. Pharr JR, Bungum T. Health disparities experienced by people with disabilities in the United States: a Behavioral Risk Factor Surveillance System study. Global journal of health science. 2012;4(6):99-108.
  9. Matin, B.K., Williamson, H.J., Karyani, A.K. et al. Barriers in access to healthcare for women with disabilities: a systematic review in qualitative studies. BMC Women's Health 21, 44 (2021). https://doi.org/10.1186/s12905-021-01189-5
  10. Henderson, J., & Henderson, P. (2021). " Don't Necessarily" Trust Me, I'm a Doctor: A Roadmap to finding a trustworthy health care provider and avoiding the dangers of not doing so. Gatekeeper Press.
  11. Hanson KW, Neuman P, Dutwin D, Kasper JD. Uncovering the health challenges facing people with disabilities: the role of health insurance. Health Aff (Millwood). 2003;Suppl Web Exclusives:W3-552-565.
  12. Taouk LH, Fialkow MF, Schulkin JA. Provision of Reproductive Healthcare to Women with Disabilities: A Survey of Obstetrician-Gynecologists' Training, Practices, and Perceived Barriers. Health Equity. 2018;2(1):207-215.
  13. Becker H, Stuifbergen A, Tinkle M. Reproductive health care experiences of women with physical disabilities. Arch Phys Med Rehabil. 1997;78(12):S26–S33.
  14. Iezzoni, L. I., Wint, A. J., Smeltzer, S. C., & Ecker, J. L. (2017). Recommendations about Pregnancy from Women with Mobility Disability to Their Peers. Women's health issues : official publication of the Jacobs Institute of Women's Health, 27(1), 75–82. https://doi.org/10.1016/j.whi.2016.09.004
  15. Khoury AJ, Hall A, Andresen E, Zhang J, Ward R, Jarjoura C. The association between chronic disease and physical disability among female Medicaid beneficiaries 18-64 years of age. Disability and health journal. 2013;6(2):141-148.
  16. Capriotti T. Inadequate cardiovascular disease prevention in women with physical disabilities. Rehabil Nurs. 2006;31(3):94-101.
  17. Kroll T, Jones GC, Kehn M, Neri MT. Barriers and strategies affecting the utilisation of primary preventive services for people with physical disabilities: a qualitative inquiry. Health & social care in the community. 2006;14(4):284-293.