Healthcare Access for People with Disabilities: Examining Social Determinants of Health Related to Healthcare Coverage

Research Objectives: To demonstrate the macro dynamics of healthcare access and disablement by comparing pressures on a broad range of issues related to health insurance and disablement across states.

Design: Examination of US Census Data, American Community Survey (ACS), using statistical hypothesis testing.

Setting: Data for this nationally representative study are from the ACS, with state level aggregated measures from the Annual Disability Statistics Compendium.

Participants: ~3,500,000 US adults via the ACS with state level aggregated measures from the Annual Disability Statistics Compendium.

Interventions: No interventions, this is a natural experiment.

Main Outcome Measures: Healthcare Access for people with disabilities was measured by aggregating metrics to the state level for all community dwelling adults as a percent of those with health insurance.

Healthcare access was tested across a series of social determinants of health metrics: ratio of people with and without disabilities; annual income for those with and without disabilities; veteran disability status with various levels of service-related injuries; veteran benefit status; health insurance and poverty gap across racial groups for those with and without disabilities; and minimum wage rate.

Results: For state level health insurance coverage, 89.2% of disabled adults have health insurance. Of disabled adults, 46.3% have private and 53.7% have public insurance. The insurance gap between disabled and nondisabled adults is 1.27%, however in some states disabled adults have more insurance coverage than nondisabled adults (range: -5.5%-6.7%)

A multitude of state level factors are associated with higher levels of health care access for disabled adults: higher minimum wage (r2=.320,p= < 0.001); larger poverty gaps between disabled and nondisabled adults (r2=0.549,p=0.002); lower veteran compensation (r2=0.549,p=0.006); larger health insurance gaps between disabled and nondisabled adults (r2=0.215,p=0.004); higher nondisabled adult annual income (r2=0.266,p= <.0.001); higher disabled adult annual income (r2=0.218,p= <.0.001); more veterans who have between a 10-60% service connected disability rating (r2=0.202,p=0.026); fewer veterans who have a 70% or higher service connected disability rating (r2=0.202,p=0.004); fewer veterans who have a service connected disability rating (r2=0.107,p=0.014).

Conclusions: In rehabilitation, healthcare access is of the utmost importance when seeking services. Healthcare access, through insurance, is especially important for disabled adults in the United States. We argue that the multi-dimensional nature of healthcare access, through the ratio of disabled and nondisabled adults; annual income for those with and without disabilities; veteran disability status with various levels of service-related injuries; veteran benefit status; health insurance and poverty gap across racial groups for those with and without disabilities; and minimum wage rate are key.

Author(s) Disclosures: Authors have no disclosures.