Chartbook on Disability in New York State, 1998 - 2000

Health Care Coverage, Access and Utilization

Access to adequate and affordable health care is a greater problem for persons with disabilities than for the general population. Persons with disabilities are disproportionately poor, making it difficult for them to purchase insurance, make required co-payments, or purchase essential services and equipment for their rehabilitation.1 Moreover, persons with disabilities may have greater difficulty in finding a physician who is knowledgeable about their ongoing health care needs. They may also have problems obtaining timely medical care and assistive technology that can help prevent minor health problems from becoming significant complications.1 It is important for a person with a disability to have access to appropriate care during the full course of a disabling condition. Such care should be provided in a way that prevents secondary conditions and maximizes the person’s ability to function in everyday social roles.1

The charts that follow in this section depict areas of health care coverage, access, and utilization for persons with disabilities. A portion of the information came from items in the Health Care Access module, which was a core section of the BRFSS from 1998 to 2000. The issue of the adequacy of insurance coverage is addressed in terms of affordability of needed doctor visits among those who have health care coverage. Information on preventive uses of the health care system by persons with disabilities is presented, including recent routine checkups, cancer screening, blood cholesterol checks, and immunizations (influenza and pneumonia). The Women’s Health module was included as a BRFSS core section from 1998 to 2000 and provided the data on cervical and breast cancer screening. Information on colorectal cancer screening came from the Colorectal Cancer Screening module in the 1999 BRFSS core. Also included in the 1999 core were the three modules Cholesterol Awareness, Immunization, and Oral Health. The issue of oral health among persons with disabilities is represented by how recently they visited a dentist or dental clinic.

Health Care Coverage

Questions: Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare? [If "yes"] What type of health care coverage do you use to pay for most of your medical care?

People of working-age (18-64 years) with disabilities fared somewhat better than the rest of the population in having coverage, with 7.4% of the subgroup needing assistance reporting no insurance coverage compared to 12.2% of those with no disabilities. However, the population of persons without disabilities was far more likely to have private coverage (79.9%) than either those needing assistance (41.6%) or those needing no assistance (66.1%). Coverage under a public program (e. g., Medicare and Medicaid) was far greater for those needing assistance (50.9%) than for those without disabilities (7.9%). [Appendix B: Table B-3]

Compared to the rest of the population, working-age adults with disabilities requiring assistance were more likely to report health care coverage; this coverage, however, was more likely to be under a public, government-funded plan.

Health Care Coverage (Private/Other, Public, Uninsured) among New Yorkers Aged 18 - 64, by Disability Status.

Inadequate Insurance

Questions: Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare? [If "yes] What type of health care coverage do you use to pay for most of your medical care? Was there a time during the last 12 months when you needed to see a doctor, but could not because of the cost?

Although working-age adults with disabilities are at least as likely as, if not more likely than, the rest of the population to have some type of health insurance coverage [see Figure 12], this coverage may not always be adequate to meet their health care needs. Of the population covered by insurance, working-age adults with disabilities were more likely than those without disabilities to report a time during the prior year in which cost kept them from a needed visit with a doctor. The difference was especially notable among those aged 45-64 years, as 17.8% of those needing assistance reported being underinsured compared to only 3.3% of those without disabilities. There were no differences, however, among those aged 65 years and older, as the likelihood of not having adequate insurance was less than 5%, regardless of disability status. [Appendix B: Table B-4]

Working-age persons with disabilities were more likely than those without disabilities to report being underinsured.

Percentage of Adult New Yorkers Who Were Underinsured (Insured, but Could Not Afford Doctor Visit Past Year?, by Age Group and Disability Status.

Recent Checkup

Question: About how long has it been since you last visited a doctor for a routine checkup?

The percentage of people reporting having had a routine checkup in the past year varied by disability status. Persons needing assistance were the most likely to have had a recent checkup, regardless of age. Among those aged 18-44 years, 71.3% of those with no disabilities reported a checkup during the prior year, compared to 75.8%% of those with disabilities not requiring assistance and 84.8%% of the subgroup needing assistance. The comparable figures for those aged 45-64 years were 80.7%, 87.9%, and 95.5%, respectively. In general, the likelihood of having a recent routine checkup increased with age, regardless of disability status. [Appendix B: Table B-4]

Persons with disabilities, especially those requiring assistance, were more likely to have had a routine checkup in the past year then were those with no disabilities.

Percentage of Adult New Yorkers Who Had a Routine Checkup within the Past 12 Months, by Age Group and Disability Status.

Colorectal Cancer Screening: Blood Stool Test

Question: A blood stool test is a test that may use a special kit at home to determine whether the stool contains blood. Have you ever had this test using a home kit?

When assessed by disability status, the likelihood of having a recent blood stool test differed by age. Among those aged 50-64 years, persons with disabilities requiring assistance were more likely than those without disabilities to report having had a blood stool test in the prior year (34.8% vs. 15.7%, respectively). Among those aged 65 years and older, however, those needing assistance were less likely than those with no disabilities to report a recent blood stool test (17.3% vs. 33.9%, respectively). [Appendix B: Table B-5]

Among those aged 50-64 years, persons with disabilities requiring assistance were more likely than those without disabilities to have had a blood stool test in the past year. Among those aged 65 years and older, however, the opposite was found.

Percentage of Adult New Yorkers Aged 50 Years and Older Who Had a Blood Stool Test within the Past 12 Months, by Age Group and Disability Status.

Colorectal Cancer Screening: Sigmoidoscopy or Colonoscopy

Question: A sigmoidoscopy or colonoscopy is when a tube is inserted in the rectum to view the bowel for signs of cancer and other health problems. Have you ever had this exam?

Among those aged 50-64 years, persons with disabilities requiring assistance were more likely than either those not needing assistance or those with no disabilities to report having ever had a sigmoidoscopy or colonoscopy (51.0% vs. 34.3% and 32.3%, respectively). Among those aged 65 years and older, the likelihood of having had a sigmoidoscopy or colonoscopy did not differ by disability status. [Appendix B: Table B-5]

Among those aged 50-64 years, persons with disabilities requiring assistance were more likely than the rest of the population to have ever had a sigmoidoscopy or colonoscopy.

Percentage of New Yorkers Aged 50 years and Older Who Have Ever Had a Sigmoldoscopy or Colonoscopy, by Age Group and Disability Status

Cervical Cancer Screening: Pap Smear

Questions: A Pap smear is a test for cancer of the cervix. Have you ever had a Pap smear? [If "yes"] How long has it been since you had your last Pap smear? Have you had a hysterectomy?

In general, the likelihood of having had a Pap smear within the previous 3 years did not vary by disability status or age. Over 85% of the population of adult women aged 18-64 years who had not had a hysterectomy reported a Pap smear within the past 3 years. Among those aged 65 years and older, those without disabilities were somewhat more likely than those needing assistance to have had a recent Pap smear (69.4% vs. 54.4%, respectively). [Appendix B: Table B-5]

The likelihood of having had a Pap smear within the past 3 years did not differ by disability status.

Percentage of Adult Female New Yorkers Who Had a Pap Smear within the Past 3 Years, by Age Group and Disability Status.

Breast Cancer Screening: Mammogram

Questions: A mammogram is an x-ray of each breast to look for breast cancer. Have you ever had a mammogram? [If "yes"] How long has it been since you had your last mammogram?

Among women aged 40-64 years, the likelihood of having had a mammogram within the past 12 months did not differ by disability status. Among those aged 65 years and older, however, women with disabilities requiring assistance were less likely than those with no disabilities to report a mammogram within the past year (49.8% vs. 67.6%, respectively). [Appendix B: Table B-5]

Among women aged 65 years and older, those with disabilities requiring assistance were less likely than those without disabilities to report a mammogram within the previous year.

Percentage of Female New Yorkers Aged 40 and Older Who Had a Mammogram within the Past 12 Months, by Age Group and Disability Status.

Breast Cancer Screening: Clinical Breast Examination

Questions: A clinical breast exam is when a doctor, nurse, or other health professional feels the breast for lumps. Have you ever had a clinical breast exam? [If "yes"] How long has it been since your last breast exam?

An clinical breast examination was considered age-appropriate if it was within the past 3 years for women aged 20-39 years and within the past 12 months for those aged 40 years and older. The likelihood of an age-appropriate clinical breast exam did not differ by disability status, regardless of age. [Appendix B: Table B-5]

The likelihood of an age-appropriate clinical breast exam did not differ by disability status.

Percentage of Adult Female New Yorkers Who had an Age - Appropriate Clinical Breast Exam, by Age Group and Disability Status.

Blood Cholesterol Check

Questions: Blood cholesterol is a fatty substance found in the blood. Have you ever had your blood cholesterol checked? [If "yes"] About how long has it been since you last had your blood cholesterol checked?

Among those aged 18-44 years, persons with disabilities requiring assistance were more likely than those without disabilities to report a blood cholesterol check within the previous 2 years (73.6% vs. 54.0%, respectively). Among those aged 45 years and older, there were no differences by disability status. [Appendix B: Table B-6]

Among those aged 18-44 years, persons with disabilities requiring assistance were more likely than persons with no disabilities to have had their blood cholesterol checked within the previous 2 years.

Percentage of Adult New Yorkers Who Had Blood Cholesterol Checked within Past 2 Years, by Age Group and Disability Status.

Immunization: Influenza Vaccination

Question: During the past 12 months, have you had a flu shot?

Among those less than 65 years of age, persons with disabilities requiring assistance were more likely than those with no disabilities to have had a flu shot within the past 12 months. This difference was found among those aged 18-44 years (42.8% vs. 14.4%, respectively) and those aged 45-64 years (47.0% vs. 27.1%, respectively). The likelihood of a flu shot increased with age, regardless of disability status. [Appendix B: Table B-6]

Among those under 65 years of age, persons with disabilities requiring assistance were more likely than those with no disabilities to have had a flu shot within the previous 12 months.

Percentage of Adult New Yorkers Who Had Flu Shot within Past 12 Months, by Age Group and Disability Status.

Immunization: Pneumonia Vaccination

Question: Have you ever had a pneumonia vaccination?

Among those aged 18-44 years, the likelihood of ever having had a pneumonia vaccination was very low regardless of disability status. Although the percentages are still low among those aged 45-64 years, persons with disabilities requiring assistance were more likely than either those not needing assistance or those without disabilities to report a pneumonia vaccination (32.9% vs. 13.6% and 7.7%, respectively). Among those aged 65 years and older, persons with disabilities were somewhat more likely to have had a pneumonia vaccination. [Appendix B: Table B-6]

Among those aged 45-64 years, persons with disabilities requiring assistance were more likely than the rest of the population to have had a pneumonia vaccination.

Percentage of Adult New Yorkers Who Ever Had Pneumonia Vaccination, by Age Group and Disability Status.

Oral Health: Visit to Dentist or Dental Clinic

Question: How long has it been since you last visited a dentist or a dental clinic for any reason?

In general, persons with disabilities were less likely than those without disabilities to have had a dental visit within the previous 12 months. This was especially true among those aged 45 years and older. Among those aged 45-64 years, persons with disabilities not requiring assistance were less likely than those with no disabilities to report a recent dental visit (57.6% vs. 77.3%, respectively). Among those aged 65 years and older, persons requiring assistance were less likely than those without disabilities to have had a dental visit within the previous year (43.2% vs. 73.5%, respectively). [Appendix B: Table B-6]

Persons with disabilities were less likely than those with no disabilities to have had a dental visit within the previous 12 months.

Percentage of Adult New Yorkers Who Visited Dentist or Dental Clinic within Past 12 months, by Age Group and Disability Status.

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