Academic journal article Journal of Applied Rehabilitation Counseling

Determinants of Health Care Access after Spinal Cord Injury

Academic journal article Journal of Applied Rehabilitation Counseling

Determinants of Health Care Access after Spinal Cord Injury

Article excerpt

Abstract -

This paper presents a review of the literature examining determinants of access to health care among individuals with spinal cord injury (SCI). The literature shows that health insurance, race-ethnicity, income, age, gender, and residential location (rural/urban) are common themes discussed in the literature as factors that influence access to health care of persons with SCI. This review ends with discussion of implications for rehabilitation counseling research and practice.

Keywords: spinal cord injury, health care, access, rehabilitation counseling.

Traumatic spinal cord injury (SCI) occurs unexpectedly. Often SCI is accompanied with permanent motor and sensory losses that completely transform the life of the individual (Krause & Broderick, 2004). In 2011, the National Spinal Cord Injury Statistical Center (NSCISC, 2011) estimated that approximately 265,000 persons live with SCI in the United States. The estimated incidence of SCI in the United States is approximately 40 cases per million persons (DeVivo, 2010; NSCISC, 2011). SCI results in substantial functional limitations that challenge quality of life of individuals, and they require the use of multiple resources to sustain and maintain functioning. As Matter et al. (2009) stated, "People with SCIs need timely, high-quality information about health and medical issues after discharge and throughout their lifetime to improve self-care and maximize quality of life" (p. 545).

Emergency hospitalization after SCI is followed by expensive acute and long-term rehabilitation. Evans and Stoddart (1994) stated that developed nations "devote a very large proportion of their economic resources to the production of health care.... Such massive efforts reflect a widespread belief that the availability and use of health care is central to the health of both individuals and population" (p. 27). Despite extensive funding for health in developed countries, disparities in access to health care persist within subgroups (e.g., older persons, ethnic minorities, and persons with low socioeconomic status). For instance, in the United States health disparities are less prevalent among older adults due to access to Medicare, whereas a higher prevalence of health disparities exists among individuals with low income and who are members of racial-ethnic minority groups (Lee, 201 0). Healthcare services for individuals with SCI have improved over several decades, leading to improved health outcomes and increased life expectancy. Despite improved health care, challenges of access and disparities in health outcomes persist based on certain characteristics of individuals with SCI. Characteristics of individuals with SCI that are associated with disparities in health outcomes include race-ethnicity, age, gender, and residential location. Several studies have documented persistent disparities in access to health care for people with and without disabilities in the United States, despite efforts to improve health and quality of life of the American population. For instance, millions of people do not have health insurance coverage that will enable them more access to health care (Barr, 2008; Richardson, & Norris, 2010; Williams, 2005). The Department of Health and Human Services (DHHS, 2004) defined health disparities as "the differences in incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population in the United States" (para. 8). Multiple factors determine access or lack of access to health care. For instance, to have access to health care, individuals must have access to multiple resources. Such resources include health information, health promotion/prevention activities, safe housing, nutritious food, a convenient and safe space for physical exercise, social support, and financial resources (Richardson & Norris, 2010).

Although there are disparities in access to health care in the general population, these disparities are more pronounced among people with disabilities when compared to the general population. …

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