A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
More than 20 million Americans ages 18-64 reported having a disability in 2014, according to the 2014 United States Disability Status Report. Previous research has shown that adults with disabilities, especially physical disabilities, are more likely to develop long-term health problems than adults without disabilities. Getting regular checkups with a dentist, and preventive care such as annual flu shots, can help to prevent health problems or maintain health. In a recent NIDILRR-funded study, researchers looked at whether adults with physical and nonphysical disabilities were more or less likely than adults without disabilities to get blood pressure checks, flu shots, or annual dental checkups. They also wanted to find out what other factors were associated with getting these services.
Researchers at the Collaborative on Health Reform and Independent Living (CHRIL) analyzed data from the Medical Expenditures Panel Survey (MEPS), a national survey of healthcare use among people living in the community. The respondents for this study included 75,145 adults aged 18-64 who completed the MEPS between 2003 and 2012.
On the MEPS, the respondents were asked whether or not they had a disability, and to describe the type(s) of limitations they experienced if they did have a disability. The respondents were classified as having a physical disability if they said they had difficulty walking, climbing stairs, bending, lifting, or grasping objects. The respondents were classified as having a nonphysical disability if they said they had other limitations but did not have difficulty with any of the above tasks. A third group of respondents reported not having any disability.
The respondents were asked whether or not they had gotten a blood pressure check, a flu shot, or a dental checkup in the past year. They also answered several demographic questions including their gender, level of education, income, medical or dental insurance coverage, as well as chronic health conditions they had (such as high blood pressure, diabetes, arthritis, or emphysema). Finally, the respondents were asked whether or not they had a “usual source of care,” -- a healthcare professional they could see on a regular basis (besides going to the emergency room).
The researchers found that among the respondents:
- Adults with disabilities were more likely to get their blood pressure checked than adults without disabilities: 92% of the respondents with physical disabilities and 83% of the respondents with nonphysical disabilities had gotten a blood pressure check in the last year, compared with 70% of the respondents without disabilities.
- Adults with physical disabilities were more likely to have gotten an annual flu shot: 40% of the respondents with physical disabilities and 30% of the respondents with nonphysical disabilities had received a flu shot, compared with 23% of the respondents without disabilities.
- Adults with disabilities were less likely to have gotten an annual dental checkup than adults without disabilities: 45% of the respondents with physical disabilities and 52% of the respondents with nonphysical disabilities had had a dental checkup within the past year, compared with 59% of the respondents without disabilities.
- Adults with disabilities were more likely to have medical insurance: 80% of the respondents with physical disabilities and 77% of the respondents with nonphysical disabilities reported having insurance, compared to 76% of the respondents without disabilities.
- However, adults with disabilities were less likely to have dental insurance: only 38% of the respondents with physical disabilities and 48% of the respondents with nonphysical disabilities reported having dental insurance compared to 67% the respondents without disabilities.
When the researchers compared the likelihood of different groups receiving preventive services, they found that
- Regardless of disability status, women were more likely to get all three preventive services than men.
- Adults with at least a college degree and family income at least four times the federal poverty level were more likely to get the three preventive services than the respondents with less than a high school degree or family income below the federal poverty level.
- Regardless of disability status, adults with more than one chronic health condition were more likely to get preventive care but less likely to get dental checkups than those without these conditions.
- Regardless of disability status, adults with a usual source of care were more likely to get all three preventive services than those without a usual source of care.
As noted by the authors, these findings seem to indicate that working-age Americans with disabilities receive more of some preventive services than working-age Americans without disabilities, with the exception of dental care. Although a majority of Americans with disabilities have some type of health insurance, less than half of adults with disabilities have dental insurance. Policymakers may want to consider including dental coverage in healthcare plans, particularly for low-income adults with disabilities.
The authors also noted that having a primary care provider, or other usual source of care, greatly increases the likelihood that working-age individuals with and without disabilities will receive timely access to preventive care. More research is needed to identify healthcare plans that promote access to a consistent care provider for people with disabilities. Further research is also needed to examine factors that can improve the physical accessibility of healthcare facilities.
To Learn More
The Collaborative on Health Reform and Independent Living (CHRIL) offers an online, self-paced tutorial on disability and health insurance. The course provides consumers and advocates a basic understanding of the US health insurance market, and the challenges people with disabilities face in obtaining and maintaining affordable and comprehensive insurance coverage.
CHRIL has also published a plain language summary of this research on their website: http://www.chril.ilru.org/compared-people-without-disabilities-people-with-disabilities-get-more-preventive-care-less-dental
Health Access for Independent Living (HAIL) provides consumers with the knowledge and skills to manage their own health and health care. Program description, factsheets, and videos are available from the project website http://rtcil.org/cl/projects/r7
To Learn More About this Study
Gimm, G., Wood, E., and Zanwar, P. (2017) Access to preventative services for working-age adults with physical limitations. Archives of Physical Medicine and Rehabilitation, 98, 2442-2448. This article is available from the NARIC collection under Accession Number J7740.