Difficulties Accessing Health Care Remain for Poor, Disabled Americans

Two new articles underscore the continuing disparities in access to medical care among disabled and poor Americans. The articles were included in the October issue of Health Affairs, which focused on disparities in health care access in the United States.

In one article, researchers concluded that closures of hospital trauma centers were disproportionately affecting poor, uninsured, and African American populations. In addition, the researchers from the University of California, San Francisco (UCSF) found that nearly a fourth of Americans are now forced to travel farther than they once did to reach a trauma center.

“Trauma centers aren’t just for ‘certain’ people—if you sustain a serious injury from a car accident or fall off your roof, you need a trauma center,’’ lead author Renee Y. Hsia, MD, an assistant professor of emergency medicine at UCSF, said in a statement.

“We found evidence that vulnerable communities have less geographic access to trauma care, adding to their health disparities,’’ Hsia added. “This study will help us better understand how trauma center closures are affecting people.’’

Hsia and her colleagues found that between 2001 and 2007, the time required for 69 million Americans to reach the nearest trauma center increased. Previous research from Hsia has found that tens of millions of Americans do not have ready access to a certified trauma center, and that nearly a third of urban and suburban emergency rooms have closed in the last two decades.

The new study covered some 283 million people, nearly the entire United States. Nearly three-quarters of the US lives within 10 miles of a trauma center, but of the remainder, 14% live more than 30 miles from a trauma center. Communities with a higher number of residents under the federal poverty level, black residents, uninsured residents, and rural residents faced longer drives compared to communities with a low share of these vulnerable populations.

In another Health Affairs article, Lisa Iezzoni, MD, director of the Mongan Institute for Health Policy at Massachusetts General Hospital analyzed the disparities affecting people with disabilities and highlighted barriers that restrict their access to health services two decades after the Disabilities Act went into effect.

“A lot of attention has been paid to how health disparities affect people in racial and ethnic minority groups, and this report details how people with disabilities are also disadvantaged,” Iezzoni said in a statement. “Most of the literature about these problems has appeared in disability-centered journals that are not very accessible to many people, so one of my goals in putting together this analysis was bringing this information to a high visibility, broadly accessible journal.”

Iezzoni’s review of several broad-based surveys found disparities in preventive health care services that included lower rates of mammography and Pap tests among women with disabilities. A review of data from National Cancer Institute registries and Medicare indicated that women with disabilities diagnosed with early-stage breast cancer were less likely to receive breast-conserving surgery. Those that did receive it were less likely to receive the radiation therapy required by treatment protocol.

Similarly, patients with disabilities diagnosed with the most deadly form of lung cancer were less likely to receive surgery, the only definitive treatment. For both types of tumor, people with disabilities were significantly more likely to die from their cancers.

SourcesLonger Trips to the ER, Especially for Minorities and Poor [UC San Francisco]Health Affairs Article Focuses on Health Care Disparities Facing People With Disabilities [Masschusetts General Hospital]