Understanding the consequences of access barriers to health care: experiences of adults with disabilities.
OBJECTIVE
The study explores: (1) the scope and nature of the consequences that adults with disabilities perceive as the result of inappropriate access to health care services; (2) the variability of these consequences by demographic attributes such as disability type, gender, and health insurance type; and (3) the inter-relatedness and multidimensionality of these consequences.


METHODS
Qualitative, semi-structured, in-depth interviews were administered over the telephone to 30 participants with spinal cord injury, cerebral palsy, or multiple sclerosis as part of a nation-wide study on access and utilisation in the USA. Interviews were transcribed and coded for analysis using the qualitative analysis program, NVivo.


RESULTS
Consequences were grouped into one of five categories: social, psychological, physical, economic and independence issues. Responses differed slightly with regard to disability type, gender and health insurance type. There was substantial overlap among consequence categories. For most respondents, negative consequences were not limited to just one area--frequently, one consequence triggered others.


CONCLUSIONS
Health insurers and providers need a better understanding of the multiple consequences of access barriers. Based on this knowledge, detrimental and costly effects of inappropriate service delivery could be more effectively prevented. Implications for health care services and policy are discussed.
Neri
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NRH Center for Health and Disability Research, 1016 16th Street, NW, Suite 400, Washington, DC 20036-5750, USA. melinda.t.neri@medstar.net
Kroll
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D000328:Adult; D002547:Cerebral Palsy / Q000523:psychology / Q000534:rehabilitation; D006233:Persons with Disabilities / Q000523:psychology* / Q000534:rehabilitation; D004470:Economics, Medical; D005260:Female; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D007348:Insurance, Health; D007398:Interpersonal Relations; D007407:Interviews as Topic; D008297:Male; D009103:Multiple Sclerosis / Q000523:psychology / Q000534:rehabilitation; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000523:psychology / Q000534:rehabilitation; D014481:United States