title: [Access to care and prevention for people with disabilities in France: Analysis based on data from the 2008 French health and disabilities households surveys (Handicap-Santé-Ménages)].
abstract: BACKGROUND
  Using data from the 2008 French health and disabilities households surveys, this study examines the use of three types of routine medical care (dental, ophthalmological and gynecological care) and four preventive services (cervical cancer screening, breast cancer screening, colon cancer screening and vaccination against hepatitis B) both for people with disabilities and for those without. Two definitions of disability were retained: (1) functional limitations (motor, cognitive, visual or hearing limitations) and (2) administrative recognition of disability.
  
  
  METHODS
  For each type of care, binary logistic regression was used to test whether access to care is influenced by any of the disability indicators as well as by other explanatory variables. Two set of explanatory variables were included successively: (1) sociodemographic variables such as age, gender as well as a proxy variable representing medical needs and (2) socioeconomic variables such as level of education, household income per consumption unit, supplementary health insurance coverage, co-payment exemption and geographic variables.
  
  
  RESULTS
  Persons reporting functional limitations are less likely to access to all types of care, in a proportion that varies between 5 to 27 points, compared to persons without functional limitations, except for eye care for which no gap is observed. The same results are obtained for persons reporting an administrative recognition of disability, and more precisely for those who benefit from the Disability allowance for adults (Allocation adulte handicapé [AAH]). After adding the social variables to the model, problems of access to health care decrease significantly, showing that disabled persons' social situation tends to reduce their access to care.
  
  
  CONCLUSIONS
  This study reveals, for a broad range of care, a negative differential access to care for persons reporting functional limitations compared to those without limitations which is confirmed when identifying disability through administrative recognition. Furthermore, it also discusses factors explaining these differentials. It highlights the role of the social situation of disabled people as an additional barrier to already limited access to healthcare.
authors.affiliation: Irdes, 117 bis, rue Manin, 75019 Paris, France. Electronic address: pichetti@irdes.fr.
authors.forename: S
authors.initials: S
authors.lastname: Pichetti
authors.affiliation: Irdes, 117 bis, rue Manin, 75019 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Penneau
authors.affiliation: Irdes, 117 bis, rue Manin, 75019 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Lengagne
authors.affiliation: Irdes, 117 bis, rue Manin, 75019 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Sermet
mesh_terms: D000328:Adult; D000368:Aged; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005191:Family Characteristics; D005260:Female; D005602:France / Q000453:epidemiology; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011315:Preventive Medicine / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Access to care; Accès aux soins; Disability; Déterminants sociaux; Handicap; Social determinants