Disabled Face Health Care Disparities

A paraplegic woman could not weigh herself for her chemotherapy treatment. A woman with cerebral palsy had to have her arms taped down for radiotherapy because the staff did not have something as simple as Velcro positioning devices.

These cases are two of many that Lisa I. Iezzoni, director of Mongan Institute for Health Policy at Massachusetts General Hospital and  professor of medicine, highlighted in her analysis and commentary on disparities in health care treatment for people with disabilities.

Despite policies such as the 1990 Americans with Disabilities Act, Iezzoni reported in a paper published this month in Health Affairs that Americans with disabilities remain strikingly disadvantaged in health care, in issues ranging from inaccessibility to quality of treatment.

“Even the most basic things are often times inaccessible, like getting onto examination tables, getting into the mammography machines, getting onto the beds of  MRI scanners,” Iezzoni said.

Iezzoni said there are marked discrepancies for routine screenings as well as lifesaving operations.

For instance, women with disabilities were less likely to receive mammography and Pap test screenings, and people with disabilities are less likely to receive critical surgeries for cancers.

Behind the article is years of research by Iezzoni and her colleagues, in addition to various statistics published by organizations including the U.S. Census Bureau.

“With the article I wanted to not only capture evidence on the health care disparity but also give people who are unfamiliar with it a flavor of how we think of the word ‘disability,’” Iezzoni explained.

Iezzoni, who has used a wheelchair for 23 years due to multiple sclerosis, began her research on the issue of health care and disability after people began to approach her about the matter.

“It initially did not occur to me to do research on disabilities,” Iezzoni said. “Only after seeing that there was not much literature out there and realizing I could contribute something with my own insight, that I started doing that kind of work.”

In her article, Iezzoni broached the topic of disability in the greater context of civil rights, with hopes that her research would have a broad impact on not only policy analysts but also the research community, advocacy groups, and health care providers. Increasing accessibility and challenging erroneous assumptions and stigmas against people with disabilities are key to bridging the disparity gap in health care, she said.

“One of the reasons why the health care field is so behind on this is because they only see people with disabilities when they are sick—providers think of them as having limited lives,” Iezzoni said. “Providers see it like this: if you need to be moved, we will move you. But people with disabilities would much rather be involved in moving themselves, in being able to transfer themselves onto the examination table.”