1/ What were your motivations for undertaking this study?

A paradox: while the need for care of people suffering from a disability is often more important, especially for dental and ophtalmological care, the literature showed that access to care is reduced for them, compared with persons without a disability. Moreover, the study was motivated by the relatively new context of increased life expectancy among disabled persons, the observations of a reduced access to care and prevention, and by the government's priority of trying to reduce these inequalities (cf. Jacob Report, 2013). The aim was to learn more about this very heterogeneous population according to type of disability, socio-economic level but also with regard to their location, at home or in institutions.

2/ What are the specificities of your approach compared to other studies about health care of disabled people?

Access to care for disabled persons has especially been documented for those living at home, and compared to people without disabilities. There is now a rather rich literature on this subject, which mainly highlights physical access problems and the more disadvantaged socio-economic situation of disabled people as main factors of their lower use of health care services. However, rarer still are studies comparing access to care of persons living at home with those living in institutions. Few studies showed that institutionalisation can be associated with a higher probability of having access to dental care. But until now it was unclear whether these results were generalizable to other types of care.

3/ Do differences in access to health care or prevention of disabled persons always be in favor of people living in institutions?

Our results show a higher probability of access for people living in institutions, for all types of care except breast cancer screening for which the differential is not statistically significant. Furthermore, it must be emphasized that the differences in health care use vary according to type of care: it is low for two treatments (colon cancer screening +3 points; ophtalmological care +4 points), higher for cervical smear (+9 points) and for gynaecological care (+13 points); it reaches an even higher level for vaccination against hepatitis B (+17 points) and for dental care (+18 points).

Un droit citoyen pour la personne handicapée, un parcours de soins et de santé sans rupture d'accompagnement.
Jacob P. (2013). Ministère délégué chargé des personnes handicapées et de la lutte contre l'exclusion.

Interview by Anne Evans

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