respectability conference oct. 3-4, 2003 system-wide health-care issues for people with disabilities...
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RespectAbility ConferenceOct. 3-4, 2003
System-Wide Health-Care Issues for People with Disabilities
Laura Remson MitchellLegislative Coordinator
Member of the Executive Committee
California Disability Alliance
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Copyright 2003 by Laura Remson Mitchell.
RespectAbility ConferenceOct. 3-4, 2003
System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance
Key Disability-Related Health-Care Issues
Most problems fall into following categories: Focus on cost-containment Accessibility of care Access to affordable health coverage Delivery of covered benefits Benefits design/definition of medical
necessity
RespectAbility ConferenceOct. 3-4, 2003
System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance
Focus on cost-containment
Threatens benefits Examples:• Medi-Cal benefit cuts, eligibility• Medicare restrictions• Restrictions/cutbacks on covered benefits in
private sector
RespectAbility ConferenceOct. 3-4, 2003
System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance
Focus on cost-containment Important Buzz Words
• “Cost-effectiveness”Biggest bang for health-care buck.
• Good if goal is best care for individual patients.• Bad if goal is primarily cost-containment and
based on total patient population.
RespectAbility ConferenceOct. 3-4, 2003
System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance
Focus on cost-containment Important Buzz Words
• “Evidence-based medicine”Requires scientific evidence to justify treatments.
• If done right (allowing other standards when evidence doesn’t exist), this could improve quality of care.
• If goal is just cost-cutting, lack of scientific evidence could be used as excuse to deny effective care for people with disabilities as well as those with rare or unusual conditions.
RespectAbility ConferenceOct. 3-4, 2003
System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance
Accessibility of care
PhysicalBuildings, equipment, etc.
Programmatic Examples: Educational programs, information, grievance/appeal procedures
CommunicationInterpreters (ASL and other), materials in alternative formats, etc.
RespectAbility ConferenceOct. 3-4, 2003
System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance
Access to Affordable Health Coverage
Losing coverage Aging out, earning out, being priced out, etc., leaves many people with disabilities vulnerable.
Risk-avoidance by health insurers and providersInsurers, health plans, hospitals and some other health-care providers often find subtle ways to avoid people with disabilities when they can’t deny coverage outright.
RespectAbility ConferenceOct. 3-4, 2003
System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance
Access to Affordable Health Coverage “Mitchell’s Corollary”:
In the absence of a level competitive playing field, bad health plans tend to drive good plans out of business. • Plans that are good for people with disabilities
attract high-cost patients, while bad plans are able to reduce costs by avoiding us.
• Result: Bad plans can offer lower premiums and take profitable business away from good plans.
RespectAbility ConferenceOct. 3-4, 2003
System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance
Access to Affordable Health Coverage
Universal Coverage and Disability• Universal health coverage could spread the risk
and put an end to cost-shifting and risk-avoidance.• We must evaluate specific proposals carefully,
then advocate to make them disability-sensitive and to assure an ongoing role for people with disabilities in running the system.
RespectAbility ConferenceOct. 3-4, 2003
System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance
Delivery of covered benefits
Barriers to care• Procedural issues (created by insurers, health
plans and administrators of publicly funded plans)• Accessibility issues• Geographical/transportation issues
Choice of providers • Access to specialty care
RespectAbility ConferenceOct. 3-4, 2003
System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance
Delivery of covered benefits
Disability stereotypes• May affect willingness of some providers to deliver
certain services (like preventive care).• May diminish health-care provider’s ability to
recognize/treat health problems unrelated to patient’s disability.
Grievance/Appeals procedures • If system isn’t accessible, it’s tough to fight back!
RespectAbility ConferenceOct. 3-4, 2003
System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance
Benefit design/definition of medical necessity
Disability-insensitive benefit designExcludes or unreasonably restricts items and services that people with disabilities need to live independent lives. Reflects black-or-white thinking about disability.• Example: Medicare covers durable medical
equipment (DME) only if needed in the home, not if needed in the community.
• Example: Failure to recognize and cover so-called “maintenance therapy” as preventive care.
RespectAbility ConferenceOct. 3-4, 2003
System-Wide Health-Care Issues for People with DisabilitiesLaura Remson Mitchell, California Disability Alliance
Benefit design/definition of medical necessity
Medical-model view of “medical necessity” Focuses on “cure” or measurable physiological improvement.
Disability-sensitive viewRecognizes “maximizing functional independence” as essential part of “medical necessity,” whether that involves improving physiological function or providing
appropriate assistive items and services.
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