National Barrier Awareness Day - Barriers to Health Care

Barriers to Health Care

• “After you turn into an adult with cerebral palsy, there is little medical support. Most of the studies, surgeries, and what have you are done with children with cerebral palsy. I walk into a doctor’s office and say I have cerebral palsy and get “that look” from the doctor. The look most adults with CP have seen numerous times in their life, the look of “Oh crap, I am going to have to Google this when I get home.” - Mary Catherine

People with disabilities encounter a range of barriers when they attempt to access health care including the following.

Prohibitive costs

Affordability of health services and transportation are two main reasons why people with disabilities do not receive needed health care in low-income countries - 32-33% of non-disabled people are unable to afford health care compared to 51-53% of people with disabilities.

Limited availability of services
The lack of appropriate services for people with disabilities is a significant barrier to health care. For example, research in Uttar Pradesh and Tamil Nadu states of India found that after the cost, the lack of services in the area was the second most significant barrier to using health facilities.

Physical barriers
Uneven access to buildings (hospitals, health centers), inaccessible medical equipment, poor signage, narrow doorways, internal steps, inadequate bathroom facilities, and inaccessible parking areas create barriers to health care facilities. For example, women with mobility difficulties are often unable to access breast and cervical cancer screening because examination tables are not height-adjustable and mammography equipment only accommodates women who are able to stand.

Inadequate skills and knowledge of health workers
People with disabilities were more than twice as likely to report finding health care provider skills inadequate to meet their needs, four times more likely to report being treated badly and nearly three times more likely to report being denied care.

Addressing barriers to health care

Governments can improve health outcomes for people with disabilities by improving access to quality, affordable health care services, which make the best use of available resources. As several factors interact to inhibit access to health care, reforms in all the interacting components of the health care system are required.

Policy and legislation
Assess existing policies and services, identify priorities to reduce health inequalities, and plan improvements for access and inclusion. Establish health care standards related to the care of persons with disabilities with enforcement mechanisms.

Service delivery

Provide a broad range of modifications and adjustments (reasonable accommodation) to facilitate access to health care services. For example, changing the physical layout of clinics to provide access for people with mobility difficulties or communicating health information in accessible formats such as Braille. Empower people with disabilities to maximize their health by providing information, training, and peer support. Promote community-based rehabilitation (CBR) to facilitate access for disabled people to existing services. Identify groups that require alternative service delivery models, for example, targeted services or care coordination to improve access to health care.

Human resources
Integrate disability education into undergraduate and continuing education for all healthcare professionals. Train community workers so that they can play a role in preventive health care services. Provide evidence-based guidelines for assessment and treatment.

WHO response

In order to improve access to health services for people with disabilities, promote strategies to ensure that people with disabilities are knowledgeable about their own health conditions and that healthcare personnel support and protect the rights and dignity of persons with disabilities.

Resources
1. Access To Medical Care for Individuals With Mobility Disabilities, U.S. Department of Health and Human Services Office for Civil Rights
2. Disability and Health, World Health Organization