Uninsured persons with disability confront substantial barriers to health care services.
BACKGROUND
Despite social "safety net" programs, many U.S. residents with disabilities lack insurance coverage and thus risk financial barriers to accessing care. The study objectives were to characterize working-age adults with disabilities who lack health insurance and to examine their self-reported barriers to care.


METHODS
The authors conducted analyses of nationally representative Medical Expenditure Panel Survey data from 2000 through 2006.


RESULTS
During this time period, 14.8% of working-age U.S. residents lacked health insurance, including 11.6% of persons with disabilities. Focusing only on uninsured individuals, persons with disabilities were significantly (p = .001) more likely than those without disabilities to have a usual source of care. However, on 6 other access measures (those that comprised our composite indicator of access barriers), uninsured persons with disabilities reported barriers significantly (p = .001) more often than did individuals without disabilities: 36.0% of uninsured persons with disabilities reported being unable to get necessary medical care, compared with 9.5% of uninsured, nondisabled persons; and 26.9% of uninsured persons with disabilities reported being unable to get necessary medications, compared with 5.3% of uninsured individuals without disabilities. Having a cognitive impairment produced the largest adjusted odds ratio (AOR) of reporting any access barrier (1.64, 95% CI 144-1.87), while having lower body functional limitations or hearing deficits also produced relatively high AORs (1.47, 1.32-1.65 and 1.48, 1.11-1.98, respectively).


CONCLUSIONS
Uninsured individuals with disabilities confront significantly more barriers to accessing care than do nondisabled persons without health insurance. Certain types of disabilities appear especially associated with experiencing access barriers, suggesting areas requiring particular attention.
Mongan Institute for Health Policy, Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston, MA 02114, USA. liezzoni@partners.org
Lisa I
LI
Iezzoni
Austin B
AB
Frakt
Steven D
SD
Pizer
D000203:Activities of Daily Living; D000328:Adult; D003072:Cognition Disorders / Q000191:economics; D017281:Cost of Illness; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000191:economics / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D055553:Prescription Drugs / Q000191:economics; D014481:United States
D055553:Prescription Drugs