Disparities in Access and Utilization among Individuals with Disabilities

An estimated one in five Americans experiences a disability. Although there is a growing body of literature related to health disparities and the factors that contribute to these disparities, the research has rarely considered health disparities among individuals with disabilities. We combine survey data from the National Health Interview Survey and the Medical Expenditure Panel Survey, pooling six years of data to enhance sample size. Through multivariate analyses, we examine two system level factors, health insurance and patient/provider interactions, three individual level factors, race and ethnicity, SES, and disability type, and their contribution to health care disparities. The measures of access and utilization draw from measures included in the series of Agency for Healthcare Research and Quality National Healthcare Disparities reports, including recent measures specific to people with disabilities (e.g., use of a hospital, emergency room or outpatient clinic as a usual source of care). Lower rates on positive access and utilization for racial and ethnic minorities, individuals of lower SES, individuals insured through Medicaid or who are uninsured and individuals who report poorer patient/ provider interactions, and higher rates on negative access and utilization for these individuals will be suggestive of health care disparities. Our analytic strategies allow us to identify subpopulations with disabilities that are disparately impacted by system and individual characteristics, ‘doubly underserved' individuals. We also examine the extent to which our system and individual level factors differentially affect individuals with disabilities, relative to individuals without disabilities.