Health care for people with disabilities: Need for systemic change

Abstract

A recent publication by Iezzoni et al titled Physicians’ Perceptions of People with Disability and Their Health Care revealed physicians’ systemic misperceptions of quality of life of people with disabilities and poor confidence in their ability to understand and accommodate the unique needs of people with disabilities in their practices, which was associated with their reluctance to accept such patients in their practices. In this perspective piece, we highlight and breakdown some of the key issues identified in Iezzoni et al’s article, discuss American Academy of Physical Medicine & Rehabilitation (AAPM&R) led initiatives that have advocated for much needed changes to curricula and disability-related competencies, and create a call to action that will ultimately lead to an envisioned future where all people with disabilities have access to high-quality health care free of prejudice and discrimination. According to the Centers for Disease Control and Prevention, 26% of adults have a disability of some type. Disability is a part of the human experience, but disability is disproportionately experienced by women, individuals with income below the federal poverty level, minorities, those with lower educational attainment, and individuals living in rural areas. People with disabilities experience discrimination and significant health care disparities including inequitable access to primary and specialty care, access to prescriptions, goodquality health care, and overall, have high rates of unmet health care needs. For example, a third of working-age adults with disabilities do not have a usual health care provider and a third have unmet health care needs. As Iezzoni et al highlight, physicians are not exempt from deficit-based perspectives about people with disabilities, and many physicians misperceive quality of life for people with disabilities. As a result, when physicians make medical judgments and care decisions, the results can be a deadly form of discrimination.