What does it mean to have a disability in Colorado?

Healthcare 

Health is defined by each individual, and having access to adequate and appropriate healthcare provides the opportunity for each person to maintain a life they consider to be healthy.  Adequate and appropriate healthcare addresses chronic health problems, acute changes in health, and education and tools to prevent disease, maintain health and reduce health risks. Establishing and maintaining good health impacts a person’s ability to function as a productive employee, care for a family and live a satisfying life.

People with disabilities in Colorado have some challenges with respect to accessing adequate and appropriate healthcare.  The statistics below show some areas that need to be addressed in order to ensure that those with disabilities can receive the healthcare they need to be as productive and active as possible.

•	31.4% of those with a disability report fair or poor health compared to only 8% of those without a disability1.
This is the result of at least three factors2:
1)	 Many people with disabilities have a health related problem that is considered chronic
2)	People with disabilities may not have easy access to healthcare providers and therefore chronic and acute healthcare issues are not always treated timely, leading to more complications. 
3)	People with disabilities are faced with limited access to healthcare providers due to transportation, inaccessible facilities and communication challenges

•	People with disabilities are more likely to engage in poor health behavior, i.e. smoking, obesity and inactivity, than those without a disability1
This could be the result of two factors2:
1)	 Limited availability of education to address risks of unhealthy behaviors
2)	Limited healthcare providers to support a healthy life style

•	People with disabilities are less likely to have healthcare insurance coverage, than those without disabilities1
This is most likely the result of2:
1)	Limited access to Medicaid due to stricter eligibility guidelines and
2)	Limited access to employer supported healthcare insurance.
•	People with disabilities are more likely to have a continuous healthcare provider1
This is easily explained by several facts2:
1)	 There are a limited number of healthcare providers who will accept Medicaid and Medicare insurance due to the decrease in reimbursement.
2)	Once a person with disabilities finds a caregiver who knows her history and care needs, and who will accept her insurance there is little incentive to change
3)	A person with disabilities may be less mobile and therefore once he finds a caregiver he has access to there is little reason to change.

Access to adequate and appropriate healthcare is dependent on many things.  Income, for example, has a direct impact on the ability to purchase health insurance or pay for healthcare services.  The ability to access transportation to a healthcare provider also has a direct impact on how easy it is to seek healthcare services when the need arises.  

Colorado has seen some success with respect to providing adequate and appropriate healthcare for people with disabilities.  The results of the study completed by Andrew Houtenville, Sept 20091, showed that people with disabilities in Colorado are more likely to be vaccinated for influenza than those without disabilities.  What this indicates is that there is adequate availability of the flu vaccine, and people with disabilities can get to the locations where the flu vaccine is being administered, such as the grocery store, drug store, or their healthcare provider.  It also indicates that the education surrounding the importance of getting the vaccine, especially for those with a chronic illness or disabilities, has been adequate and has been widely distributed2. 

Taking the example of the flu vaccine as a starting point, the availability of adequate and appropriate healthcare for those with disabilities could be improved by increasing access to healthcare insurance, allowing more to be eligible for Medicaid; providing healthcare services in easily accessible locations, perhaps with a mid-level provider (Nurse practitioner, Physician assistant); and making sure healthcare education and the tools necessary to reduce health risks, are readily available and distributed to all.

In order to increase accessibility to healthcare services it will also be necessary to increase reimbursement to those providers who will accept Medicare and Medicaid insurance. There are many providers in Colorado who will not accept new Medicare or Medicaid patients due to the fact that the reimbursement for their services is much lower than the expenses required to provide those services.  If the reimbursement for services provided to Medicare and Medicaid beneficiaries was more in line with the expenses incurred to provide those services, healthcare providers would be more open to accepting patients who are counting on these insurances to cover their healthcare needs. 

1Information was found in: Houtenville, Andrew. (Sept. 2009). Statistics Describing Population with Disabilities in Colorado: By County and CIL 
Catchment Area. Colorado SILC. Retrieved Dec. 15, 2009, from http://www.coloradosilc.org/default.htm.
2Comments in Italics are provided by Debbie Petersen, RN, MSN, MBA, immediate past chair of the Colorado Statewide Independent Living Council