Healthcare Accessibility for People with a Disability
Canadians take it for granted that we have a system of universal health care. Even though the system has become somewhat eroded in recent years, for the most part, Canadians have access to world-class medical care. For the most part. People with disabilities experience a different world of health care, and in particular, practical challenges to accessing the same health care millions of other Canadians take for granted. The four traditional barriers are physical barriers, attitudinal barriers, expertise barriers, and systemic barriers.
A Toronto-based study found that over 32% of people with disabilities experienced physical barriers accessing healthcare facilities, while a Canadian study found that ”20% of patients with disabilities felt that physicians overattributed health problems to their disability while another 20% felt physicians under-attributed… Research on how people with disabilities are perceived by family physicians shows that doctors perceive people with disabilities to be more challenging than other patients (Bachman, Vedrani, Drainoni, Tobias, & Maisels, 2006).”
A 2012 study by the Canadian Disability Policy Alliance found that barriers to healthcare for people with disabilities continue to persist. “The most prevalent patient-level barrier cost, particularly the costs of transportation to appointments. For those patients with limited financial resources, and often without independent means of transportation, traveling any distance by taxi is not an option. If accessible public transportation is available, it often will not exceed certain boundaries, so geography becomes an issue.”
Healthcare accessibility is a challenge for those individuals who choose not to reveal their disability prior to meeting with a doctor for the first time. They perceive themselves to be in good health or may have a healthcare issue that is completely unrelated to the presence of a disability. But, they find that when doctors meet them, some are reluctant to treat them. In particular, some practitioners prefer not to work with patients who cope with chronic pain or mental illness, because they find the individual takes up “too much of their time”.
Here are some of the recommendations for basic healthcare accessibility from the Center for Disease Control and Prevention:
- Floor spaces and hallways are free of equipment and other barriers.
- Counters and service windows are low enough for everyone to reach, including people who use wheelchairs.
- Alarm systems can be both seen and heard.
- Staff and health care professionals can use sign language or have access to someone who can use sign language.
- Videos on the web have captioning or written versions for people with hearing loss.
- Print materials and signs are large-size fonts for people with low vision.
- Raised lettering and Braille are used on signs, such as those on elevators.
The reality is, the offices of most GPs and specialists do not have anywhere close to this level of healthcare accessibility. Even in Ontario, where the ODA is in place, most of these basic forms of accessibility do not exist. For people in the Deaf Culture, healthcare accessibility can be an even greater challenge. For example, hospitals, walk-in clinics, GP, and specialists do not keep an Interpreter on staff. When an individual requires the services of a doctor, they must arrange the Interpreter ahead of time. But, what about in an emergency situation? Then, they are in an enormously difficult situation trying in vain to communicate with hospital staff. Again, a very basic level of accessibility should be the presence of at least one Interpreter on staff in all hospitals and walk-in clinics.
For people who are blind or have low vision, navigating a large hospital can be a nightmare. They are expected to find their way around with literally no one to assist, and the lack of materials in braille or large print.
If Canada is to create a Canadians with Disabilities Act, there must be provisions for how people with disabilities access the healthcare system. Training on disability-related issues should be mandatory for all individuals entering nursing or medical school. At the very least, there is a need for our doctors and nurses to understand the ways in which disability-related issues impact an individual, and the common misconceptions they might make when they treat an individual with a disability.
A recent article in the Canadian Journal of Disability Studies reports that “Health care is a human right yet access barriers to health care remain one of the major challenges among people with disabilities. One of the several reasons accounting for this is that there is little evidence on access barriers to healthcare among people with disabilities.” There are additional and serious problems such as an inability or difficulty moving onto and off medical equipment (such as an MRI or CT scan), staff with no ability to communicate with individuals who have language difficulties or people from the Deaf Culture. “For instance, Thew et al. (2012) and Iezzoni et al. (2004) found that deaf patients experience “fear, mistrust and frustration” in healthcare settings when they experience problems with instructions for physical examination, telephone communication, and difficulty communicating with staff. This is likely to result in incorrect diagnosis and improper treatment.”
In 2010, the College of Family Physicians and Surgeons stated that people with disabilities have far greater difficulties finding a family physician in Ontario, and they also stated only 17.5% of Ontario physicians are accepting new patients. Premier Wynne has not lived up to her promise to develop a Health Care Accessibility Standard. As of this date, the premier has still not moved forward with this initiative. The AODA Alliance is devoted to the attempt to ensure Wynne keeps her promise. The Alliance also points out Wynne’s government studied the issue for almost two years, then turned around and asked for public input. The unfortunate reality is that Premier Wynne broke her promise never to weaken any accessibility provisions or protections.
In summary, people with disabilities continue to struggle with healthcare accessibility in Canada, and one of the reasons is that politicians like Premier Wynne don’t deliver on their word.
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