Defining Programmatic Access to Healthcare for People with Disabilities

People with disabilities face disability-related barriers that affect their receipt of health care. These often are discussed in terms of three categories: financial, structural, and programmatic barriers. Financial barriers may involve the lack of insurance, inability to pay for care, or coverage limitations for such items as durable medical equipment and medication. Structural barriers primarily arise from the architectural characteristics of health care delivery settings, such as parking location, building entrances, stairs and ramps, and bathrooms. Programmatic barriers are barriers involving the processes used to deliver health care. This category is the least understood, yet an important factor for access to care. This brief offers an expanded definition of programmatic access, addressing policy or procedure for (1) communication and information, (2) scheduling and waiting, (3) conducting an examination, (4) follow-up and referral, and (5) system-wide issues. Policies or procedures in each of the 5 areas are briefly described accompanied by an explanation of why each element merits consideration. For each policy or procedure, recommended methods or actions and their rationale are offered in order to prevent the creation of a disability-related programmatic barrier to health care access.