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Health Care for Disabled Population in the US Research Paper


Abstract

A lower socioeconomic position aggravates the disadvantaged status of the disabled population, making this group especially vulnerable since their needs rarely get satisfied. The research at hand is devoted to low-income, lower-class people with disabilities, whose number is rapidly increasing worldwide. The study will provide a description of the population, account for its vulnerability, assess the unique health concerns the group has, and investigate the ways it uses the health care system. It will also dwell upon the attempts made by healthcare specialists across the country to meet the needs of disabled people with a low-income level and provide recommendations to improve the outcomes.

Introduction

There a lot of factors that make different population groups vulnerable or underserved. The major ones include a low-income level, lower class, job loss, serious or terminal diseases, race, ethnicity, the absence of insurance coverage, old age, homelessness, and disability. The health care needs of these groups are typically unmet or largely neglected (Social Security Administration, Office of Policy & Office of Research, 2013).

Despite some efforts made by the government of the United States and other countries to reduce disparities in health care through numerous policies and programs aimed to eliminate or mitigate risk factors, decrease morbidity and mortality rates, and increase access to health care, there are still millions of people living in extreme poverty, which cannot help producing a detrimental impact on their state of health (Krahn, Walker, & Correa-De-Araujo, 2015).

The relevance of the research at hand is supported by the fact that the number of people with disabilities is rapidly increasing worldwide. This worrying trend is associated with plenty of factors, including longer life expectancy, an increasing number of people suffering from cardiovascular diseases and diabetes, and environmental conditions. However, unlike other underserved groups, this one is not homogeneous since its members are not equally disabled. Those that have severe impairments (excluding them from the labor market) experience a sharp drop in income, which leads to deterioration of the condition (Krahn et al., 2015).

Thus, the paper at hand is going to prove that a lower socioeconomic position aggravates the disadvantaged status of the disabled population, making this group especially vulnerable since their needs rarely get satisfied. The study will provide a description of the population, account for its vulnerability, assess the unique health concerns the group has, and investigate the ways it uses the health care system. It will also dwell upon the attempts made by healthcare specialists across the country to meet the needs of disabled people with a low-income level and provide recommendations to improve their outcomes.

Description of the Population

According to the International Classification of Functioning Disability and Health (ICF), disability is a comprehensive term that designates many kinds of activity limitations, physical and mental impairments, and participation restrictions (Mackelprang & Salsgiver, 2016). The term was chosen to emphasize the nature of the interaction between the individual having certain health conditions and the environment (inaccessibility of public transportation and buildings, negative attitude of the society, limited or no job opportunities, limited or no financial and health support).

Currently, there are more than a billion people across the globe living with various forms of disability, which means that 15% of the world population is disadvantaged to this or that extent owing to this factor only. Approximately 110-190 million of them have significant functioning restrictions that do not allow them to earn their living (Social Security Administration, Office of Policy & Office of Research, 2013).

As a result, their disability gets aggravated due to a lower socioeconomic status and a low level of income as their health care needs are more extensive and often uncovered by the insurance (Brucker & Houtenville, 2015). The connection between poverty and disability is also supported by the fact that over 80% of the disabled come from developing countries, which allows stating that the population is affected disproportionately and there is a greater prevalence of different forms of disability among low-income people.

It is evident from the description of this disadvantaged group that the problem must be included on the list of national development activities for the following reasons (Mackelprang & Salsgiver, 2016):

  1. Demographic arguments:
    1. There are more than 53 million disabled people in the US, which means that the needs of the group cannot be ignored.
    2. Poverty is both the cause and the consequence of disability.
    3. The population of the US is aging, which increases the risks of disability.
  2. Social arguments:
    1. To ensure sustainable development of the nation, it is essential to eliminate inequalities between various population groups in terms of health care as one of the decisive components of well-being.
    2. The society cannot make any progress if a considerable part of its members is excluded from its activities due to disabilities.
  3. Economic arguments:
    1. Since disability affects the financial status of numerous individuals, it inevitably produces an impact on the economy of the country.
  4. Legal arguments:
    1. Disabled people have the same rights as all other citizens and therefore their problems must be addressed to promote equality.

What Makes the Group Vulnerable or Underserved

In most general terms, people with disabilities representing the lower class have a larger number of unmet needs also because they cannot earn their living and improve their condition resorting to expensive treatment and rehabilitation therapies. The major disadvantages they have to experience include (Brucker & Houtenville, 2015):

  • Hazardous and unhealthy living conditions. Due to their low level of income, disabled people often have inadequate housing with poor sanitation, which poses a considerable threat to their health.
  • Limited employment opportunities. Disability is typically linked to unemployment: 47% of disabled men and 80% of disabled women have no jobs. This makes it practically impossible for them to improve their social status.
  • Social exclusion from public spaces. Physical barriers prevent disabled people from participating in social events and collective decision-making.

Furthermore, the population has to deal with plenty of health care barriers when they attempt to receive the necessary medical assistance. These are (García-Gómez et al., 2015):

  • Inaccessibility of timely medical aid due to extra costs. Since the majority of disabled people need additional personal assistance from a health care professional or an assistive device, they are constantly confronted with the increased health expenditure. This makes them even poorer than before, trapping them in a never-ending circle.
  • Unavailability or restricted availability of services. Although most specific health care services required for disabled people are provided in large hospitals situated in big cities, the situation is quite different in small towns and villages, where they can receive only the basic health due to the lack of specialists or equipment.
  • Physical barriers. There are a lot of physical barriers not only in public places but also in health care units. They include narrow doorways, inadequate bathroom facilities, uneven access to buildings, internal steps and the absence of elevators, no special parking places, non-adjustable equipment, etc.
  • Insufficient knowledge or skills of the staff. It is not a rare case that people with disabilities report that health care specialists are unable to satisfy their needs or, what is even more frequent, that they are denied care. Moreover, such patients are often treated without due respect and attention.

Unique Health Concerns of the Group

As it has already been mentioned, owing to a low level of income the group experiences deficiencies in health care services covered by their insurance. Their health concerns mostly stem from this problem and include (Social Security Administration, Office of Policy & Office of Research, 2013):

  • Secondary conditions. The majority of disabled people who have no money to address their primary condition properly suffer from secondary conditions related to it (e.g. osteoporosis, pressure ulcers, pain, urinary infections, etc.). They are mostly predictable and preventable; however, the lack of finances usually deprives them of this opportunity. The most frequently met secondary conditions are:
    • bowel and bladder (typically affected by spinal cord injuries);
    • fatigue (lack of energy and increased tiredness due to the necessity to overcome pain and physical obstacles);
    • injuries (both unintentional and intentional self-harm);
    • depression or other mental and psychological conditions (owing to higher stress levels);
    • obesity (since a lot of disabilities make it impossible to be active);
    • pain (associated with the majority of disabilities but can range from short-term to chronic pain);
    • pressure ulcers (developing in bedridden patients or those who use a wheelchair).
  • Co-morbid conditions. It is also typical of disabled individuals to acquire diseases that are not related to their primary condition causing disability. For instance, patients with schizophrenia are 15% more likely to have diabetes than those who do not have this mental disability.
  • Age-related diseases. The combination of disability and poverty significantly increases the chances of premature aging (at approximately 40-50). Since this process begins earlier, the state of health quickly deteriorates.
  • Risk behaviors. Since low-income disabled individuals often cannot afford proper nutrition, their diet is unbalanced. Also, to reduce pain and stress, they often smoke or drink alcohol. In most cases, their disability limits physical activity.
  • Higher mortality rates. Due to all the enumerated factors, the disabled population usually has a lower life expectancy.

Unique Ways the Group Uses Health Care System

Besides the fact that the proportion of individuals without health insurance is much higher in the low-income, disabled populations, the sources of it also vary to a great extent. Most people under 65 without any disabilities have private insurances provided by their or their spouse’s employer. Only 4% receive public coverage provided by Medicaid or Medicare. The rest 15% are uninsured, mostly due to being disadvantaged by their race, ethnicity, socioeconomic status, or other factors.

On the contrary, the coverage pattern of the disabled is usually provided by public plans. The more severe the level of disability is, the fewer chances there are for the population to have private insurance. That is why disabled individuals can use only those services that are covered by Medicare and Medicaid (Soni, Burns, Dague, & Simon, 2017). Also, there are a lot of eligibility criteria that they have to meet to receive benefits from insurance programs. They depend on the level of income and extended to those who receive AFDC and disability payments (Riley & Rupp, 2015).

The utilization of health care services is unique for all categories of low-income disabled individuals, from children to the elderly. The level of disability is the decisive factor determining how often people resort to health care services. Nearly 2 in 3 disabled patients identify their level of health as poor or very poor as compared to 5 in 6 patients without disability assessing their condition as good or fair (Soni et al., 2017).

Another difference is the number of days spent in bed. Disabled people spent 10 times more days in bed as compared to people of the same age without disabilities. As far as visits to hospitals are concerned, disabled individuals attend physicians 3.5 times more often than regular patients (Social Security Administration, Office of Policy & Office of Research, 2013). The highest levels of disability also account for 40% of hospital stays ranging from 5 to 10 days (as compared to the average 1 day among the non-disabled) (Mackelprang & Salsgiver, 2016).

This allows stating that disabled people who have public insurance coverage due to their financial status are mostly heavy users of health care services, even even though the number of them is scarce. Both inpatient and outpatient care is more popular among this population as compared to privately covered, non-disabled patients. During the last year, more than 10% of the disabled in the United States had multiple hospital stays, mostly owing to the limited access to primary care and high health care costs (Social Security Administration, Office of Policy & Office of Research, 2013).

However, the picture is quite different from preventive care. Disabled patients are less likely to use preventive services, such as blood pressure screenings, Pap smear, dental care, flu shots, and others. Immunization is one of the services that fell short of all set national targets since less than 40% of the disabled, low-income population get shots (Social Security Administration, Office of Policy & Office of Research, 2013). The problem is that due to the obstacles enumerated in the previous sections, this vulnerable group tries to avoid visits that are not decisive for the development of their major source of disability, which is their primary (although far from being the only) health concern.

What is Done to Better Meet the Needs of the Population

To meet the needs of disabled, low-income patients by improving their access to the required health services, the World Health organization currently implements the following steps (Mackelprang & Salsgiver, 2016):

  1. Disseminating information. The organization encourages all member states to increase awareness of the problem emphasizing how it may be aggravated by economic disadvantages experienced by the group. WHO currently insists on including the population into some national programs and policies.
  2. Guiding research. The organization facilitates the collection of information on the topic to compare statistics from various countries and select the most effective techniques they implement in dealing with the issue.
  3. Developing guidelines. The organization provides normative tools needed to prepare health care organizations for handling disability.
  4. Involving policymakers. WHO encourages innovative solutions, programs, and policies that could facilitate the process of service provision to health care specialists.
  5. Providing patient education. WHO ensures that disabled people have sufficient knowledge about their condition and rights.

However, the efforts are made not only on the global but also at the national level. In the United States, there are currently two major programs that address this problem. Social Security Disability Insurance (SSDI) was specially designed for those who lost their jobs after becoming disabled. The insurance is provided under the condition that the person paid Social Security taxes for 40 quarters or more (Drake et al., 2013). Yet, the level of provision directly depends on the level of the former income, which again is not the way to solve the problem of those who did not earn a lot in the past.

As for Supplemental Security Income (SSI), this program is more general as it addresses all people having low income, no or an abbreviated history of employment, and restricted living resources. Those utilizing the program receive $735 per month and qualify for Medicaid in the majority of states (Riley & Rupp, 2015).

Nevertheless, these efforts are insufficient, which is supported by the fact that the majority of disabled people have poor living conditions and cannot find any employment even if their disability allows them to work.

Recommendations for How the Country Can/Should Better Meet the Needs of This Population

The following recommendations can be made to better address the problems of the described population (Sherlaw, Lucas, Jourdain, & Monaghan, 2014):

  1. Disabled people must receive access to all educational and employment opportunities (as long as their conditions permit) both in the private and public sectors.
  2. Social organizations should foster the development of support services, cooperatives, and other social enterprises that would render due assistance to the population.
  3. Access to healthcare facilities needs to be improved especially in rural areas where disabled people commonly dwell.
  4. Income security and health protections must be guaranteed to those who cannot provide for themselves.
  5. Principles of equal opportunity, general accessibility, and non-discrimination should be promoted by policymakers.
  6. It is essential to ensure international cooperation of organizations that have been established to address the needs of the disabled population to develop disability-specific standards and policies of poverty reduction and job creation.
  7. Population-specific programs and measures should be introduced along with those that address the general population for disabled people not to feel outcasts from society.
  8. During the implementation of new programs, it is necessary to provide effective consultations to the population so as the disabled are aware of their opportunities, benefits, and rights.
  9. Nurses and other health care professionals must receive due training on the disability issue to be able to ensure the best quality of care for disabled patients.
  10. Research needs to be conducted on the global level to compare data on the living standards of disabled people as well as on the labor market situation to monitor the progress of new policies and acts.

Conclusion

Since disability puts people in the condition of limited work opportunities, the majority of them are unable to earn their living, which aggravates their state of health. Low-income individuals with different forms of disabilities are disadvantaged by several factors simultaneously.

This makes the group highly vulnerable and underserved both socially and medically. Unfortunately, despite the steps taken by the US government to eliminate the existing disparities, it is insufficient to guarantee economic stability to the disabled. Thus, both national and international efforts are required to address the health care and socioeconomic needs of those who are now at the margins of society due to their psychical or mental condition. It is crucial to remove financial, physical, and other barriers that the population has to encounter to ensure the security and well-being of the group.

References

Brucker, D. L., & Houtenville, A. J. (2015). People with disabilities in the United States. Archives of Physical Medicine and Rehabilitation, 96(5), 771-774.

Drake, R. E., Frey, W., Bond, G. R., Goldman, H. H., Salkever, D., Miller, A.,… & Milfort, R. (2013). Assisting Social Security Disability Insurance beneficiaries with schizophrenia, bipolar disorder, or major depression in returning to work. American Journal of Psychiatry, 170(12), 1433-1441.

García-Gómez, P., Hernández-Quevedo, C., Jiménez-Rubio, D., & Oliva-Moreno, J. (2015). Inequity in long-term care use and unmet need: Two sides of the same coin. Journal of Health Economics, 39(1), 147-158.

Krahn, G. L., Walker, D. K., & Correa-De-Araujo, R. (2015). Persons with disabilities as an unrecognized health disparity population. American Journal of Public Health, 105(S2), S198-S206.

Mackelprang, R. W., & Salsgiver, R. (2016). Disability: A diversity model approach in human service practice. Oxford, UK: Oxford University Press.

Riley, G. F., & Rupp, K. (2015). Cumulative expenditures under the DI, SSI, Medicare, and Medicaid programs for a cohort of disabled working‐age adults. Health Services Research, 50(2), 514-536.

Sherlaw, W., Lucas, B., Jourdain, A., & Monaghan, N. (2014). Disabled people, inclusion and policy: Better outcomes through a public health approach? Disability & Society, 29(3), 444-459.

Social Security Administration, Office of Policy, & Office of Research. (2013). Fast Facts and Figures About Social Security 2013. Washington, DC: Government Printing Office.

Soni, A., Burns, M. E., Dague, L., & Simon, K. I. (2017). Medicaid expansion and state trends in Supplemental Security Income Program participation. Health Affairs, 36(8), 1485-1488.

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