You would think that hospitals and other medical spaces would be welcoming to a person with a disability. After all, medical facilities treat all manner of conditions and should be accessible to everyone needing help. That’s not always the case, and people with disabilities often find themselves struggling to find physicians to care for them and accessible facilities in which to be treated.
Physicians admit to actively discouraging patients with disabilities from joining their practices, citing a lack of accessibility and proper equipment — as well as their own biases — for not providing care.1 These attitudes perpetuate the healthcare disparities that disabled people experience and result in pervasive ableism.
Physical accommodations, such as adjustable-height exam tables, lifts, and scales that fit wheelchairs are expensive and often outside the budget for many providers, especially in rural areas where the disabled patient population may only be 10-15 percent. The same is true for communication accommodations, with many physicians admitting they direct most of their communication efforts towards caregivers, bypassing the patient-doctor relationship altogether.
Time is another factor that drives physicians’ reasoning behind denying care to disabled people. With the standard 15-minute appointment time, doctors just can’t assess and treat patients with complex medical needs in such a short amount of time. Disabled patients are considered a “disruption to flow.” Coordination of care takes time, maintaining EHR for these patients takes more time, and time is a resource doctors don’t have.
So, what about the Americans With Disabilities Act? Well, as it falls to the person with the disability to file a complaint about a facility or doctor, patients run into the same issues of time, knowledge, ability, and capacity that able-bodied people find difficult to get around when filing any type of claim for anything. This burden of proof on the patient means that The Americans with Disabilities Act and the subsequent ADA Amendments Act have proven difficult to enforce. To add to that, it can be difficult to prove discrimination when a physician’s clinical decision can be easily justified medically.
Without getting into the intricacies of the Social Security Administration’s SSDI (Social Security Disability Insurance) and SSI (Supplemental Security Income) programs, the same burden of proof that applies to lodging an ADA claim also applies to navigating the world of Medicare or Medicaid claims, programs that are available to people receiving SSDI and SSI, respectively. The more complex the illness or disability, the more complex the claim and subsequently the more room for significant errors in coding and billing. Again, the burden of identifying these errors falls to the patient, and the risk of not doing so results in higher healthcare costs for the patient, loss of revenue for critical hospitals and providers, and perpetuates the worrisome health/money cycle for those for whom it affects the most.
People with disabilities — intellectual, physical, or developmental — face higher healthcare needs, more barriers to accessing services, and less health coverage, resulting in worse health outcomes, according to the 2019 and 2022 Missing Billion reports. Additionally, people with disabilities have a 2.4-fold higher mortality rate and are short 10 to 20 years of life expectancy over their non-disabled counterparts. These stats are even more dramatic when disability intersects with other forms of marginalization. Disparities multiply when the disabled person is also a person of color, female, and/or older.
There are persistent, antiquated views that disability runs counter to ideas of health, and there is much work to do to dismantle long-established beliefs about the capacity and ability of people with disabilities and what it means to be disabled in 2024. The majority of public health and research expenditure in this area goes to preventing disabilities, and whilst these efforts are important, it is shortsighted to minimize research that promotes the health and well-being of those currently residing in the disability space. Focusing mainly on prevention perpetuates stigma, ableism, and inequities in the disability community.
Despite the initial expectations that the ADA’s anti-discrimination measures would eliminate healthcare barriers for disabled individuals, significant and enduring inequities persist. Systemic issues have long hindered the full integration of many disabled individuals into US society. The National Institutes of Health has formally designated people with disabilities as a population with health disparities, which will help ensure their representation in NIH research. This is a step in the right direction, but there is much more to be done to realize the ADA’s goal of inclusion and opportunity for all people with disabilities.
1 Lagu, T., Haywood, C., Reimold, K., DeJong, C., Sterling, R. W., & Iezzoni, L. I. (2022). ‘I am not the doctor for you’: Physicians’ attitudes about caring for people with disabilities. Health Affairs, 41(10), 1387–1395. https://doi.org/10.1377/hlthaff.2022.00475