Rationing health care to disabled people

Abstract

Combining a political economic perspective with a case study approach, this paper examines the intent, process, and consequences of rationed care for disabled people under the U.S. managed care system. Two disabled persons were followed over a three-year period as they sought care for major episodes relating to chronic depression and post-polio syndrome. The findings illustrate a marked disparity between the concept and goals of rationed care and the experience of consumers of services. For these people, care is rationed at the service level and also in terms of restricted access to, and payment for, the care sought. This often results in inadequate treatment and inflated costs. These problems are due in large part to the competitive nature of the major stakeholders, institutional coalitions that work against patients, emphasis on profit maximisation, devaluing of the lives of disabled people and the weak bargaining position that disabled persons hold as consumers.

Disability and Pap Smear Receipt Among U.S. Women, 2000 and 2005

“…8 Similarly, individuals with disabilities may become frustrated with organizational features of health care financing that leave them financially drained after major disability-related care, which suggests that they may forgo preventive care as a cost-saving strategy. 10 In addition, delay in seeking needed medical care may be growing for the U.S. population as a whole; 35 the uninsured and insured, many of whom experience higher than average deductibles and copayments, delay care because of cost as well as logistic barriers, such as trouble getting through to a doctor's office on the telephone or scheduling timely appointments. Our findings, when considered in the context of previous research, suggest that future work examine health systems barriers beyond insurance to understand underutilization of cervical cancer screening and other preventive reproductive health services for women with and without disabilities.…”

“…24,26–29 Finally, medical personnel may provide care to women with disabilities that is too “disability-focused”: care that views disabling conditions, rather than other health concerns, as the object of treatment. 8,10 Such care likely diminishes individuals with disabilities' odds of receiving preventive services unrelated to their disabling condition. All of these factors lead us to expect that women with disabilities are less likely than others to receive a recommendation for a Pap smear.…”

Accommodating health and social care needs: routine resource allocation in stroke rehabilitation

“…Allocative decisions are not concerned with specific treatments or services, rather they take place on a minute by minute basis as health and social care professionals attempt to do the best they can within the resource constraints within which they work. Many of these choices are not formulated in a straightforward way to exclude or include; rather they are decisions that are made by individual service providers simply managing their workload (Allen 2001, Griffiths 2001) and which add up and interact over the course of a caring trajectory (Albrecht 2001). As Light and Hughes (2001) point out, whilst the recent Sociology of Health and Illness monograph on rationing made an important contribution to the sociology of resource allocation, a key weakness in the studies described was the lack of outcome measures and also an understanding of the accumulative effects of rationing on whole episodes of care.…”

Hysterectomy and Disability Among U.S. Women

“…The association between disability and having a hysterectomy has not been thoroughly considered in previous research. The health of women with disabilities in general has received relatively little attention, even though these women may be more vulnerable than others to adverse consequences of inadequate health care access . Indeed, they frequently face multiple forms of inequality that put them at a health disadvantage relative to other women—like low socioeconomic status and depression…”

“…The health of women with disabilities in general has received relatively little attention, 9,10 even though these women may be more vulnerable than others to adverse consequences of inadequate health care access. [11][12][13] Indeed, beginning at birth, but for the purposes of this analysis, each woman' s exposure to the risk of undergoing a hysterectomy begins at age 15-the earliest age at which the Centers for Disease Control and Prevention' s hysterectomy surveillance statistics are collected.…”