Health care under the ADA: A vision or a mirage?

Problems in health care access are identified using recent studies documenting the health disparities experienced by people with disabilities. Some of these health care access barriers qualify as discrimination prohibited under the Americans with Disabilities Act. Focusing on the past decade of ADA enforcement, issues reported in the U.S. Department of Justice listing of resolved ADA complaints and settlements are compared to the profile of access problems. Key court case outcomes of the past decade also are presented. These sources indicate that the majority of resolved complaints and settlements involved failure to provide effective communication (often sign language interpretation). A smaller percentage of complaints and settlements addressed issues of refusal to provide treatment, physical access, equipment access, and provider procedures. Most of the key settlements involved hospitals and larger provider organizations, while many complaints also focused on individual physicians. Although the record indicates that the ADA can be, and has been, effectively used to increase access in many instances, other types of access problems have been lightly addressed through application of the ADA. This likely stems from enforcement choices made by the Department of Justice and the dynamics of the patient-doctor relationship. The broad challenge for the coming decade is to develop means to achieve effective communication and eliminate physical and programmatic barriers in more health care provider settings more consistently. The ADA can be a vigorous force in this effort as part of a multipronged strategy.