Abstract:
BACKGROUND:An overarching question in health policy concerns whether the current mix of public and private health coverage in the United States can be, in one way or another, expanded to include all persons as it does in Canada. As typically high-end consumers of health care services, people with disabilities are key stakeholders to consider in this debate. The risk is that ways to cover more persons may be found only by sacrificing the quantity or quality of care on which people with disabilities so frequently depend. Yet, despite the many comparisons made of Canadian and U.S. health care, few focus directly on the needs of people with disabilities or the uninsured among them in the United States. This research is intended to address these gaps. Given this background, we compare the health care experiences of working-age uninsured and insured Americans with Canadian individuals (all of whom, insured) with a special focus on disability. Two questions for research guide our inquiry: (1) On the basis of disability severity level and health insurance status, are there differences in self-reported measures of access, utilization, satisfaction with, or quality of health care services within or between the United States and Canada? (2) After controlling covariates, when examining each level of disability severity, are there any significant differences in these measures of access, utilization, satisfaction, or quality between U.S. insured and Canadian persons? METHODS:Cross-sectional data from the Joint Canada/United States Survey of Health (JCUSH) are analyzed with particular attention to disability severity level (none, nonsevere, or severe) among three analytic groups of working age residents (insured Americans, uninsured Americans, and Canadians). Differences in three measures of access, one measure of satisfaction with care, one quality of care measure, and two varieties of physician contacts are compared. Multivariate methods are then used to compare the healthcare experiences of insured U.S. and Canadian persons on the basis of disability level while controlling covariates. RESULTS:In covariate-controlled comparisons of insured Americans and Canadians, we find that people with disabilities report higher levels of unmet need than do their counterparts without disabilities, with no difference in this result between the nations. Our findings on access to medications and satisfaction with care among people with disabilities are similar, suggesting worse outcomes for people with disabilities, but few differences between insured U.S. and Canadian individuals. Generally, we find higher percentages who report having a regular physician, and higher contact rates with physicians among people with disabilities than among people without them in both countries. We find no evidence that total physician contacts are restricted in Canada relative to insured Americans at any of the disability levels. Yet we do find that quality ratings are lower among Canadian respondents than among insured Americans. However, bivariate estimates on access, satisfaction, quality, and physician contacts reveal particularly poor outcomes for uninsured persons with severe disabilities in the United States. For example, almost 40% do not report having a regular physician, 65% report that they need at least one medication that they cannot afford, 45% are not satisfied with the way their care is provided, 40% rate the overall quality of their care as fair or poor, and significant reductions in contacts with two types of physicians are evident within this group as well. CONCLUSION:Based on these results, we find evidence of disparities in health care on the basis of disability in both Canada and the United States. However, despite the fact that Canada makes health insurance coverage available to all residents, we find few significant reductions in access, satisfaction or physician contacts among Canadians with disabilities relative to their insured American counterparts. These results place a spotlight on the experiences of uninsured persons with disabilities in America and suggest further avenues for research.
journal_name
Disabil Health Jjournal_title
Disability and health journalauthors
Gulley SP,Altman BMdoi
10.1016/j.dhjo.2008.07.006subject
Has Abstractpub_date
2008-10-01 00:00:00pages
196-208issue
4eissn
1936-6574issn
1876-7583pii
S1936-6574(08)00077-0journal_volume
1pub_type
杂志文章abstract:BACKGROUND:Prior research has established health disparities between people with and without disabilities. However, disparities within the disability population, such as those related to type of disability, have been much less studied. OBJECTIVE:To examine differences in chronic conditions and health status between su...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2013.04.006
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:A substantial and increasing population of US women of childbearing age live with disability. Disability-based disparities in access to family planning services have been previously documented, but few studies have used population-based data sources or evidence-based measures of disability. OBJECTIVE:To det...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2017.03.014
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:Women with disabilities experience higher rates of intimate partner violence (IPV) than the general population. Reproductive coercion, a type of intimate partner violence, is associated with an increased risk of unintended pregnancy (UIP), yet little is known about this relationship among women with disabili...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2019.100849
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:Young adults with cerebral palsy (CP) are reported to be less active than their typically developing peers, have higher rates of sedentary behaviors, engage in slower tempo activities, and overall participate in a smaller variety of physical activities (PA). Functional motor level and environmental barriers ...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2019.02.008
更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:Physical activity is an essential component of a healthy lifestyle. Health clubs encourage sustained healthy lifestyles but are still largely not accessible to people with disabilities. Cost is a barrier for accessibility enhancements. HYPOTHESIS:We postulate that: (A) universal design coupled with a social...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2020.101006
更新日期:2020-09-18 00:00:00
abstract:BACKGROUND:Caregiving roles of children <18 years of age living with parents with health conditions or disability have been studied extensively abroad, but little U.S. research has examined the caregiving activities and perceptions of children with parents with significant physical disability. OBJECTIVE:To examine chi...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2015.10.009
更新日期:2016-04-01 00:00:00
abstract:BACKGROUND:Assistive technology (AT) is one strategy to mitigate or eliminate barriers to independence for individuals with disabilities, including those with spina bifida (SB). However, little is known about current use and costs of AT for people with SB, including the cost burden to medical insurance payees. OBJECTI...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2009.10.009
更新日期:2010-07-01 00:00:00
abstract:BACKGROUND:Women with disabilities report fewer pregnancies than those without disabilities. OBJECTIVE:To explore the range of factors involved in pregnancy decision-making among women with disabilities, and give insight into the decision making process. METHODS:Data were obtained from 4 focus groups conducted with 2...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2017.02.011
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:Little is known about the availability and technical quality of online information related to the medical care of people with disability, despite the potential of this information to alter clinical interactions and treatment decisions. OBJECTIVES:This review examines the utility of internet search engines f...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2019.100877
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:Limited study has been done on proxy responses for non-respondents with subjective cognitive decline (SCD) on the Behavioral Risk Factor Surveillance System (BRFSS). OBJECTIVE:To directly compare results for survey respondents with SCD with those for proxies provided for non-respondents with SCD. METHODS:P...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2016.09.004
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:Deaf American Sign Language (ASL) users comprise a linguistic minority population with poor health care access due to communication barriers and low health literacy. Potentially, these health care barriers could increase Emergency Department (ED) use. OBJECTIVE:To compare ED use between deaf and non-deaf pa...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2015.05.004
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:Between 250,000 and 400,000 individuals in the United States are diagnosed with Down syndrome (DS). Nearly all adults with DS will develop Alzheimer's disease pathology starting in their thirties. Recent studies suggest that increased physical activity (PA) may be important for maintaining components of cogn...
journal_title:Disability and health journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.dhjo.2018.02.003
更新日期:2018-07-01 00:00:00
abstract:BACKGROUND:Women with disabilities experience significant health disparities. A barrier to progress in addressing these disparities is the lack of population-based data on their health outcomes, which are needed to plan health care delivery systems. Administrative health data are increasingly being used to measure the ...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2020.100909
更新日期:2020-07-01 00:00:00
abstract:BACKGROUND:Achieving and maintaining health are no less important to people with a disability than they are to anyone else; it is just typically more challenging. This report explores sport as a mechanism of health for people with a disability. The International Classification of Functioning, Disability and Health (ICF...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2009.01.002
更新日期:2009-07-01 00:00:00
abstract:BACKGROUND:Hip osteoarthritis, a common age-associated condition, produces considerable disability that may be influenced by a variety of factors other than age. This study examines the magnitude and impact of the presence of comorbid and/or concurrent depression and anxiety symptoms on the disability experienced befor...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2008.10.001
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Individuals with disabilities are a health disparity population with high rates of risk factors, lower overall health status, and greater health care costs. The interacting effect of employment, health and disability has not been reported in the research. OBJECTIVE:This study examined the relationship of em...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2012.11.001
更新日期:2013-04-01 00:00:00
abstract:BACKGROUND:Stroke reduces active life expectancy, both years lived and their proportion without disability. However, active life expectancy studies have provided limited information about strokes in the United States, those occurring throughout older life, or those affecting African Americans. OBJECTIVE:To measure ass...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2014.06.005
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:Perceived social support has been found to be associated with depression, subjective well-being and psychological health in cross-sectional studies in people with physical disabilities. No longitudinal studies have been conducted to examine these associations over time using a comprehensive measure of social...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2018.09.005
更新日期:2019-04-01 00:00:00
abstract:BACKGROUND:Advances in medical care have increased the long-term survival of patients with spina bifida. Despite this growing population, limited knowledge is available on age-related illnesses in adults with spina bifida, particularly prostate cancer for which there is no published data. OBJECTIVE:Our aim was to desc...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2019.100866
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:Women with intellectual and developmental disabilities (IDD) are bearing children at increasing rates. However, there is very little research about pregnancy experiences and birth outcomes among women with IDD. No studies to date have examined birth outcomes with a US population-based sample. OBJECTIVE:The ...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2017.02.010
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:Florida has the third largest population in the U.S. of persons living with disabilities, making optimizing health outcomes for this population paramount. Though the state has a long-standing and robust program to reduce tobacco use, prevention efforts do not specifically target persons with disabilities. O...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2013.01.008
更新日期:2013-07-01 00:00:00
abstract:BACKGROUND:Most studies that investigate the impact of pain on function have focused on a particular pain site and use unidimensional measures of disability, making it difficult to know how pain impacts on different areas of functioning and whether different pain characteristics impact differently on function. AIM:To ...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2013.04.007
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:The transition to adulthood, the gradual change in roles and responsibilities, is identified as a challenging time for adolescents and young adults with physical disabilities, including those with cerebral palsy. Health care, education, employment, independent living, and community engagement have been ident...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2016.09.008
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:Given the unpaid nature of the work, informal caregiving can create a financial burden for caregivers. Little has been done to identify specific predictors of experiencing financial burden. This study investigated demographic and health factors comparing caregivers who reported having or not having financial...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2011.08.001
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:Prior studies on the impact of disabling work injury have neglected social support as a key mediating factor. This study investigates how permanent impairment from a work injury affects marital formation, an indicator of social support and integration with the potential to affect psychosocial adjustment and ...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2012.10.001
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:There is a need to examine health care utilization of individuals with the rare conditions muscular dystrophies, spina bifida, and fragile X syndrome. These individuals have a greater need for health care services, particularly inpatient admissions. Prior studies have not yet assessed 30-day all-cause readmi...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2018.08.009
更新日期:2019-04-01 00:00:00
abstract:BACKGROUND:To implement appropriate programs for promoting physical activity (PA) in people who are Deaf, it is important to have valid instruments for assessing PA in this population. OBJECTIVE:The main purpose of this study was to examine the criterion validity of the short form of the International Physical Activit...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2016.06.005
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:While cross-sectional data have been invaluable for describing national trends in disability over time, we know comparatively little, at a population level, about the long term experiences of persons living with a disability over the adult life course. OBJECTIVE:In this paper we use nationally representativ...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2013.08.008
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:Emerging research demonstrates that light-intensity physical activity is favorably associated with numerous health outcomes among the general population, even independent of high-intensity physical activity. OBJECTIVE:To examine the association between accelerometer-assessed light-intensity physical activit...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2017.08.007
更新日期:2018-04-01 00:00:00
abstract:BACKGROUND:Many health conditions have been described in children with Down syndrome (DS). However, there are little comparative population-based data available. OBJECTIVE/HYPOTHESES:We sought to examine the health impacts associated with DS and other disabling conditions in U.S. children included in the 2005-2006 Nat...
journal_title:Disability and health journal
pub_type: 杂志文章
doi:10.1016/j.dhjo.2010.06.001
更新日期:2011-04-01 00:00:00