Serious barriers exist that reduce the quality of health care available to women with physical disabilities. Architectural barriers in physicians' offices and hospitals still exist, despite the requirements of the Americans with Disabilities Act. There are invisible barriers as well, such as policies that deny service to women who cannot independently mount an examination table, and the refusal of physicians to see women solely on the basis of their disability, also in violation of the Americans with Disabilities Act. Advocacy is needed to inform persons in charge of medical facilities and clinical practices about their obligation to comply with legal requirements for physical and policy accessibility.
Our finding that women with disabilities make significantly greater use of services from specialists and emergency rooms has strong implications. With the advent of managed care, there are more stringent regulations on the use of specialists. For women whose health depends on timely access to physicians who have the specialized knowledge they need, these regulations could seriously affect their ability to maintain good health and prevent minor conditions from escalating into major ones that require more involved and more expensive treatment. Many of the complications of immobility and disability-related diagnoses are not taught in primary care training programs. A specialist may be the most appropriate primary care provider for some women with disabilities. This may also be an insight into the disproportionately high use of emergency rooms we found among women with disabilities. The many barriers to accessing health care, both within medical systems and in the community (such as lack of accessible transportation and attendant services) contribute to delayed treatment. When knowledgeable providers are not available or when systems barriers prevent them from delivering services in a timely manner, otherwise controllable health problems become ones that can only be handled in an emergency room. When we see the use of emergency room services declining, we will know that health care systems have made progress in removing some of these barriers to quality health care service.