Disparities in Access to Health Care

The Boston Globe covers a recent study by the ARC of Massachusetts on health disparities for adults with disabilities, giving particular coverage to the issue of adults remaining under the care of pediatricians because internists won't see them. The ARC solicited information from adults with disabilities, parents and guardians, community support professionals, physicians, and other health care professionals.

The report found that, among other reasons, many internists avoid disabled patients because of uneasiness with them.

Also, many doctors feel that insurers do not pay enough to compensate them for the longer time it often takes to listen to - and care for - these patients.

Oh yes, I do (unhappily) concur with that assessment. I use a speech device which slows things down and can upset doctors who are not used to it (I've literally had doctors become hostile when they saw the device). The general questions health care professionals are taught to ask make no sense to me, so it takes forever for a support person just to explain to me what the doctor wants to know. The list of barriers goes on... Two years ago at my most recent attempt at a basic exam, the office refused to schedule extra time for me, resulting in the need to go back for a second appointment--along with the trauma that entails for both for me and for the poor soul who goes with me. I was then graciously (see: sarcasm) allocated 20 minutes instead of 15. So I left with my medical questions unanswered.

Apparently I was lucky--at least that internist agreed to see me at all. (I have not had the same luck however with dentists.)

The notion of health disparities, the difference in quality of heath care between people from different populations, comes originally from work with racial, ethnic, or cultural minorities. It applies just as much to the minority population of people with disabilities.

In a 2006 review focusing on people with intellectual disabilities, the issue is described as a "cascade of disparities" ("A Cascade Of Disparities: Health And Health Care Access For People With Intellectual Disabilities", citation and full text download) including yes, access issues, but also issues of poor health in general, poor health practices, and poor health promotion. Improving access to medical care may be only one piece of the solution.

I do hope ARC of MA posts more details on their study in the weeks ahead. Health disparities are a serious issue for many autistic adults.