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J Epidemiol Community Health. 2007 April; 61(4): 367.
PMCID: PMC2652950

More than ramps. A guide to improving healthcare quality and access for people with disabilities

Edited by L I Iezzoni, B L O'Day. Published by Oxford University Press, Oxford, 2006, £38.00 (hardcover), pp 366. ISBN 10: 0-19-517276-0

The book is a goldmine. It covers disability and access to healthcare, healthcare experiences of people with disabilities and improving their healthcare in the USA. The authors give invaluable insights, being researchers/doctors who have experienced disabilities and who have spent much time with people having disabilities. The work is well constructed, documented, written and accessible to everyone. To illustrate various problems, the authors use clear examples and figures plentifully, which are easier to understand than written descriptions of the issues. Pertinent statistics are provided to state different issues. The roles of the Americans with Disabilities Act, Medicare, Medicaid and private insurance schemes are well discussed. The limitation to physical and sensory disabilities, which affect most people with disabilities, reduces the work complexity. Musculoskeletal disorders are common in workers.

Chapter 1 covers the roots of the problem, defining disability, health insurance and accessing the healthcare system. It begins with the door of a clinic as a metaphor. Generally, a door is made to be closed, but in this case, it must be made to be opened. Insurance and healthcare are not always accessible to people with disabilities for a number of reasons. Disabilities are associated with lower social conditions. People with disabilities daily face financial, organisational, geographical, sociodemographic, interpersonal and attitudinal impediments. The suppression of these issues is a societal challenge because of its cost and social barriers. The concept, definition and history of disabilities are clearly presented. The WHO International Classification of Functioning, Disability and Health presents disability as a common feature on a continuum over the lifespan of the human condition. Disabilities affect many young people and 42% of subjects aged >65 years in the US (2000 census). The International Classification of Functioning, Disability and Health, in fact, only suggests a theoretical definition of disability. Healthcare financing and other systems remain rooted in classic thinking. Certain disabilities could be defined as perceived disabilities only. Health insurance and healthcare access are crucial and exceed the resources of people with disabilities. Their lack increases disease, disability and premative mortality. Technical aids improve quality of life, prevent injury and reduce healthcare expenditures. The costs will increase with the “baby boom” generation. Rethinking fundamental coverage policies for all citizens is a pressing societal challenge.

Chapter 2 leads us to perceive the healthcare experiences of people with disabilities regarding costs, health insurance, finding a willing/knowledgeable doctor, physical location, doctor's technical knowledge, attitudes, guide animals, examining tables, lack of accommodation, interpersonal communication, etiquette and communication during examinations, and interactions with office staff. Clinicians' training about disabling conditions and technical competence is important. Boundaries of healthcare systems regarding personal and technical aids, dental services, public transportation and accessible housing are examined. These are more difficult and stressful for persons with disabilities. They need more healthcare and each visit lasts for a longer time. Different types of payments/insurances and needs are discussed. Reimbursements must be sufficient to attract care providers.

Chapter 3 examines and suggests some improvements for healthcare using universal designs to accommodate all users at home and in public spaces, making spaces and equipments accessible, designing accessible healthcare settings by removing barriers for new constructions or renovations and by involving people with a variety of disabilities as experts, considering patients as experts of their lives and needs, focusing on chief complaints and not disabilities, collaborative clinician–patient care approach, self‐management care, tools for shared clinical decision making, self‐management technological aids, improving patient–clinician communication, accommodating communication and making information accessible using procedural and technological options, questions to ask and training of clinicians. Patient–patient communication is also important. The internet, with some guidelines, is useful in enhancing communications and knowledge. Finally, the authors provide arguments for building person‐centred, healthy and accessible communities that could improve living conditions and accommodate persons with disabilities.

The book is a valuable social and scientific contribution. It will help anybody to realise the conditions of persons with disabilities and their circle. It focus on the issues in the USA, but similar issues occur in other countries. Every citizen, especially care providers, teachers, politicians, researchers and students, must read it.


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