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The canary in the mine.

Lisa I Iezzoni1

  • 1Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. liezzoni@caregroup.harvard.edu

Archives of Physical Medicine and Rehabilitation
|October 9, 2002
PubMed
Summary

People with disabilities face significant health care access barriers, highlighting systemic issues. Their experiences reveal critical gaps in care quality, demanding inclusive system reforms.

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Area of Science:

  • Health Services Research
  • Disability Studies
  • Public Health Policy

Background:

  • Individuals with disabilities encounter unique challenges in accessing healthcare services, including insurance coverage limitations and difficulties with specialist appointments and transportation.
  • These barriers place them at the forefront of systemic healthcare deficiencies, acting as an early warning for broader system failures.

Discussion:

  • The healthcare experiences of people with disabilities exemplify the 'quality chasm,' a gap between ideal and actual healthcare delivery.
  • The Institute of Medicine's six aims for healthcare reform—safe, effective, patient-centered, timely, efficient, and equitable—are particularly relevant to improving care for this population.

Key Insights:

  • Persons with disabilities often struggle to obtain services and technologies not covered by insurance, despite needing ongoing clinical vigilance and support.
  • They face greater obstacles in follow-up care, specialist access, travel, and after-hours support compared to the general population.

Outlook:

  • Fundamental healthcare system reform is necessary, with a particular focus on the needs of vulnerable populations like individuals with disabilities.
  • Engaging people with disabilities, their families, and communities in designing and directing healthcare system changes is crucial for achieving equitable and effective care.

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