Barriers to care of people who have disabilities and coverage for health care

The objective is to assess the barriers to health care encountered by people with disabilities who are fully covered for their health care, so that they have no financial barriers. The population consists of 40 very poor persons with mental disorders, intellectual disabilities, alcohol or drug problems, HIV/AIDS, or chronic illnesses. Seven one-hour focus groups to elicit their experience with the health system, with 4 to 10 individuals each, yielded 221 statements of which 150 were non-identical. They were classified by content analysis with triangulation in 4 main categories of barriers relating to the organization of the services (56), the interaction between client and providers (54), the lack of knowledge of physicians and other providers (21) and problems with the policy (chiefly Medicaid)(19). These categories contained up to 8 specific types of barriers. This study reveals that there are many serious barriers to services for people with disabilities even when the services are paid for, it identifies these barriers, and it suggests specific points that should be considered in US health care reform to eliminate them.