Incentivizing, enforcing and improving disability accessible health care: Current gaps and potential solutions

Despite federal requirements for health care organizations (HCOs) to provide accessible care to patients with disability, care often remains inaccessible.

To explore stakeholders' perspectives of the effectiveness of federal requirements and factors motivating HCOs to provide accessible care to patients with disability.

We conducted 55 interviews with key informants (e.g., Disability Coordinators, researchers, policymakers, professional organizations, advocates) between May 2019 and August 2020. All interviews were conducted by qualitatively trained researchers and analyzed using content analysis methodology.

We identified 3 themes: 1) existing laws are necessary, but not sufficient; 2) education is needed for health care organizations on disability as an equity issue; 3) health care is motivated by cost, quality and competition.Interview participants reported legal mandates as a major mechanism incentivizing healthcare organizations to invest in accessible care for patients with disability. These mandates, enforced through patient lawsuits and complaints, have been ineffective in driving systemic change.Additionally, organizational leaders lack knowledge on their legal obligations to provide equitable access to healthcare and the needs of patients with disability. Participants identified a need for research demonstrating that accessible care improves outcomes and costs. Finally, participants expressed a desire for methods to facilitate competition amongst healthcare organizations to encourage provision of accessible care.

Federal requirements are necessary but insufficient in ensuring accessibility. Alternative solutions are needed which educate leadership and align with cost, quality and competition incentives. Diversifying the levers which incentivize accessible care could drive meaningful change in equitable healthcare for patients with disability.