Achieving accessible health care for people with disabilities: why the ADA is only part of the solution

People with various disabilities encounter numerous physical and programmatic barriers to receiving health care of equal quality and effectiveness as that received by people without disabilities. Litigation and settlement negotiations under such federal laws as the Americans with Disabilities Act of 1990 have resulted in the removal of access barriers in specific instances, but have not yet resulted in the kind of systemic change needed in the health care delivery system. This article analyses some of the factors that make accessible health care so difficult to achieve. Accessible health care is viewed through a public health lens by which changes in public policy and social views of disability are necessary for achieving sustainable long-term success. The advantages and disadvantages of judicial policy making in the analogous contexts of tobacco cessation and Title VI medical discrimination in the United States is briefly discussed. The powerful but blunt tool of litigation is analyzed as only one tool among an array of public policy and legislative tools needed to effect barrier removal in the field of health care, especially among the smaller provider clinics and practices where a majority of outpatient visits take place. Lawsuits and other policy tools, such as enacting further legislation to link accessibility standards to federal agency enforcement, creating federally funded technical assistance centers that will disseminate practical policy and procedural tools to providers, and mandating the gathering of disability-specific disparities and effectiveness data, must work in concert to transform our health care system.