The intersection of disability and healthcare disparities: A conceptual framework

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Article describes the main conceptual frameworks that have been used in analyzing disparities in healthcare access and quality and evaluates those frameworks in the context of healthcare for individuals with disabilities. The specific models examined include: the Aday and Anderson Model, the Grossman Utility Model, the Institute of Medicine (IOM) models of Access to Healthcare Services and Healthcare Disparities, and the Cultural Competency model. While existing frameworks advance understandings of disparities in healthcare access and quality, they fall short when applied to individuals with disabilities. Specific deficits include a lack of attention to cultural and contextual factors (Aday and Andersen framework), unrealistic assumptions regarding equal access to resources (Grossman’s utility model), lack of recognition or inclusion of concepts of structural accessibility (IOM model of Healthcare Disparities) and exclusive emphasis on supply side of the healthcare equation to improve healthcare disparities (Cultural Competency model). In response to identified gaps in the literature and short-comings of current conceptualizations, the authors propose the Model of Healthcare Disparities and Disability (MHDD), an integrated model of disability and healthcare disparities that more comprehensively explains the experience of healthcare disparities for individuals with disabilities. The MHDD provides a framework for conceptualizing how a mismatch between personal and environmental factors may result in reduced healthcare access and quality, which in turn may lead to reduced functioning, activity, and participation among individuals with impairments and chronic health conditions.

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