Discrimination Shapes Care Access for Patients with Disabilities

Researchers found that patients with disabilities continue to experience unequal care access impacted by provider discrimination and implicit bias, even 30 years after the passage of the Americans with Disabilities Act (ADA) prohibiting healthcare discrimination based on disability status.

Under ADA Title II (a public entity) or ADA Title III (a private entity serving the public), healthcare entities must provide equal care access for people with disabilities and make reasonable accommodations to enable such access.

Despite these protections, a new study published by Health Affairs found that physicians deny care to people with disabilities and have biased attitudes toward disabilities.

“Our body of work suggests that physician bias and discriminatory attitudes may contribute to the health disparities that people with disabilities experience,” Tara Lagu, MD, director of the Institute for Public Health and Medicine’s Center for Health Services and Outcomes Research at Northwestern University Feinberg School of Medicine, and a professor of hospital medicine and medical social sciences, said in a press release.

“We need to address the attitudes and behavior that perpetuate the unequal access experienced by our most vulnerable patients,” continued Lagu, who is also a corresponding study author

In three focus groups involving about 22 participants, physicians identified multiple barriers to providing care for people with disabilities.

All participants reported physical barriers to providing healthcare for people with disabilities, including accessible buildings and equipment to conduct basic health assessments.

Providers were asked to respond to the question, “If a wheelchair user comes and cannot stand on a weight scale, what is your approach to taking a weight?”

Physicians from two of the three groups said they would send patients to a supermarket, grain elevator, zoo, or cattle processing plant to obtain the weight, the study stated.

Additionally, none of the focus group participants could provide communication accommodations through written materials in Braille. Many providers stated they relied on caregivers during healthcare encounters.

“A lot of times, the caregivers are able to give us a lot more information without communicating with the patient directly. That’s how we get the information that we need from the caregivers,” a primary care physician said to one of the researchers.

When providers were asked about their knowledge of the ADA, nearly all physicians reported having little or no training on ADA laws and its implications for their practices.

Physicians in the study not only described a lack of knowledge about providing accommodations for people with disabilities, but some also expressed oppositional attitudes toward the ADA.

“I truthfully think the [Americans with Disabilities] Act makes the disabled person more of a target and doesn’t help them but hurts them," a physician stated in the study. “Because a lot of us, me personally, are afraid to treat them...so I look at it as not [a] helpful act, but I look at it as a hurtful act… I think we're pretty open as sitting ducks for lawsuits if we try to get rid of a patient with disabilities because they can turn around and say that it was discrimination.”

Physicians in all three groups noted the lack of sufficient knowledge, experience, and skills among themselves and their clinic staff concerning care for people with disabilities.

Some participants described denying care to people with disabilities or attempting to discharge people with disabilities.

Specifically, a specialist said they told a patient, “I think you need a lot more care, and I am not the doctor for you."

These attitudes and barriers may further exacerbate the health disparities that people with disabilities already face.

Prior studies have shown that disparities in care access and care quality will worsen chronic disease management for people with disabilities.

“Meaningful improvements in access to high-quality care for people with disabilities will require a multipronged approach and should include changes to medical education, efforts to increase the presence of accessible equipment, and changes in our approach to physician reimbursement,” said study co-author Carol Haywood, PhD, research assistant professor of medical social sciences at Feinberg, in the press release. “At Northwestern, we are working to lead change through research and also through advocacy and improvement efforts such as the Disability Advocacy Coalition in Medicine, patient safety and quality efforts at Northwestern Memorial Healthcare, and the NM Champion Network Disability Chapter.”