2010 FDR - Chapter 2: Health

Health and disability are wholly intertwined: health problems can lead to disabilities, and disabilities can lead to health problems. Access to health care services is a key issue for Canadians both with and without disabilities. Many people with disabilities have increased requirements for health care services, and it is important to recognize those needs to ensure that all people have access to the same range, quality and standard of health care services.

Since an individual’s experience of his or her disability is unique to that individual, it is essential to recognize that the need for health care services will differ greatly among people with disabilities. This chapter focuses on understanding the important relationship between severity of disability and three aspects of health care services: visits to different types of health professionals, medication usage and the usage of health-related aids and devices.

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Health professionals

Access to needed health professionals Footnote 10 is an important pillar of an accessible health care system. Since many people with disabilities have an increased need for health care services, it is important to understand the extent to which they use health professionals and the types of barriers that they may encounter.

Visits to health professionals

Physicians, including family doctors and specialists, are the most common type of health professional sought by people with disabilities; 88.0% of adults with disabilities visited a physician at least once in 2005–2006, Footnote 11 and 32.3% visited a physician at least once a month. Over half of adults with very severe disabilities visited a physician at least once a month. The frequency of visits to a physician in 2005–2006 by people with disabilities is shown in Chart 2.1.

Chart 2.1: Frequency of visits to physicians in 2005–2006 by severity of disability for adults (%)

A text description of Chart 2.1 is provided below
Chart 2.1 Text Description

This vertical bar graph illustrates the frequency of visits to physicians in 2005 to 2006 by severity of disability for adults (percent)
The chart is divided into five sections, each section representing the severity of disability. The horizontal axis lists the disability range from mild through very severe. On this axis from left to right are the following categories:

  • Mild
  • Moderate
  • Severe
  • Very severe
  • Total

The vertical axis is measured by percentages and increases by increments of 10 from 0 to 100.

For those with mild disabilities, 1.3 percent visited the doctor at least once a week, 16.7 percent visited the doctor at least once a month and 63.4 percent visited the doctor less than once a month.

For those with moderate disabilities, 2.4 percent visited the doctor at least once a week, 27.5 percent visited the doctor at least once a month, and 58.7 percent visited the doctor less than once a month.

For those with severe disabilities, 5.1 percent visited the doctor at least once a week, 39.0 percent visited the doctor at least once a month, and 49.1 percent visited the doctor less than once a month.

For those with very severe disabilities, 9.0 percent visited the doctor at least once a week, 43.7 percent visited the doctor at least once a month, and 41.6 percent visited the doctor less than once month.

In total, 3.6 percent of adults with disabilities visited the doctor at least once a week, 28.7 percent visited the doctor at least once a month, and 55.7 percent visited the doctor less than once a month.

Source: Statistics Canada, 2006 Participation and Activity Limitation Survey

In addition to severity of disability, gender and age also influence health care experiences. Women with disabilities are slightly more likely than men with disabilities to have visited a physician in 2005–2006 (90.1% versus 85.4%). As age increases, so too does the likelihood of having visited a physician: 75.2% of young adults with disabilities visited a physician, compared to 91.2% of seniors.

People with disabilities also require the services of other health professionals. Chart 2.2 displays the percentage of all adults with disabilities who visited other types of health professionals at least once in 2005–2006.

Chart 2.2: Visits to various types of health professionals at least once in 2005–2006 for adults with disabilities (%)
Type of health professional Percentage
Physiotherapists or occupational therapists 20.3
Chiropractors 13.8
Massage therapists 12.6
Psychologists, social workers or counsellors 11.9
Audiologists or speech therapists  8.0
Chart 2.2 Text Description

This chart describes what type of health professional adults with disabilities visit by percentage.

20.3 percent of adults with disabilities visited physiotherapists or occupational therapists in 2005 to 2006.

13.8 percent visited chiropractors in 2005 to 2006.

12.6 percent visited massage therapists in 2005 to 2006.

11.9 percent visited psychologists, social workers or counsellors in 2005 to 2006.

8.0 percent visited audiologists or speech therapists in 2005 to 2006.

Source: Statistics Canada, 2006 Participation and Activity Limitation Survey

There are clear connections between disability type and type of health professionals visited. For example, 18.4% of adults with hearing disabilities visited an audiologist or a speech therapist in 2005–2006, compared to 3.5% of adults with disabilities who did not have hearing disabilities and 8.0% of people with disabilities overall. Likewise, 43.0% of adults with mental health disabilities visited a psychologist, social worker or counsellor, compared to 6.9% of adults with disabilities who did not have mental health disabilities and 11.9% of people with disabilities in general.

Children with disabilities also have health care needs. However, whereas 88.0% of adults with disabilities visited a family doctor or general practitioner at least once in 2005–2006, only 77.3% of children with disabilities did the same. Other common types of health professionals visited include paediatricians, speech therapists and medical specialists such as cardiologists and neurologists.

Out-of-pocket costs associated with visiting health professionals

While many Canadians have health care plans that help pay for at least part of their health-related expenses, out-of-pocket costs are still a reality: 24.3% of Canadian adults with disabilities who visited at least one health professional in 2005–2006 had out-of-pocket expenses for those visits. Among adults with disabilities who had out-of-pocket costs for health professional visits, the average amount was $642.58. Younger working-age adults with disabilities are more likely to incur costs than seniors with disabilities (29.3% versus 20.2%).

Among those who had out-of-pocket expenses, there is a significant relationship between severity of disability and the level of out-of-pocket costs, as shown in Chart 2.3. Adults with severe to very severe disabilities spend about 40% more on average for health professional visits than those with mild to moderate disabilities.

Chart 2.3: Average out-of-pocket costs for visits to health professionals in 2005–2006 by severity of disability for adults who had out-of-pocket costs ($)
Severity of disability Average Expense
Mild to moderate 550.15
Severe to very severe 766.70
Total 642.58
Chart 2.3 Text Description

This chart describes (by severity of disability) the average out-of-pocket costs for adults with disabilities that had out-of-pocket costs in 2005 to 2006.

For individuals with mild to moderate disabilities the average out-of-pocket expense in 2005­ to ­2006 is 550.15 dollars.

For individuals with severe to very severe disabilities, the average out-of-pocket expense in 2005­ to ­2006 is 766.70 dollars.

The total average out-of-pocket expense for adults with disabilities in 2005­ to ­2006 is 642.58 dollars.

Source: Statistics Canada, 2006 Participation and Activity Limitation Survey

Unmet health care needs

In 2005–2006, 14.8% of adults with disabilities needed health care or social services because of their conditions but were unable to obtain them. Severity of disability is highly correlated with having such unmet needs. Of adults with very severe disabilities, 30.0% have unmet health care needs, compared to 7.0% of those with mild disabilities. Younger adults are also more likely to have unmet needs: 21.6% of younger working-age adults with disabilities have unmet needs, compared to 8.9% of seniors with disabilities.

As mentioned above, adults with disabilities have substantial out-of-pocket costs related to visits to health professionals. Not surprisingly, cost-related barriers—such as visits to health professionals being too expensive or visits not being covered by insurance—are the most common barriers experienced, regardless of severity of disability. Adults with severe to very severe disabilities are more likely than those with milder disabilities to not know how or where to obtain the health care they need. Chart 2.4 provides reasons why adults with disabilities have unmet health care and social services needs.

Chart 2.4: Reasons for unmet health care and social services needs by severity of disability for adults, 2006 (%)

A text description of Chart 2.4 is provided below
Chart 2.4 Text Description

This vertical bar graph illustrates the reasons for unmet health care and social services needs by severity of disability for adults, 2006 (percent)

The chart is divided into five sections, each section representing what percentage of unmet health care and social services needs there are for one of three groups mild to moderate, severe to very severe and total. Along the vertical axis are 5 sections (from left to right):

  • Not available in area
  • Not covered by insurance
  • Too expensive
  • Do not know where/how to obtain services
  • Condition not severe enough

The vertical axis is measured by percentages and increases by increments of 5 from 0 to 50.

For the section described as “not available in area”, 14.6 percent of adults with mild to moderate disabilities had unmet health care and social services needs. 16.7 percent of adults with severe to very severe disabilities had unmet health care and social services needs. The total percentage of adults with disabilities with unmet health care and social services needs due to unavailability in area is 15.9 percent.

For the section described as “not covered by insurance”, 35.3 percent of adults with mild to moderate disabilities had unmet health care and social services needs. 32.7 percent of adults with severe to very severe disabilities had unmet health care and social services needs. The total percentage of adults with disabilities with unmet health care and social services needs due to insufficient insurance coverage is 33.7 percent.

For the section described as “too expensive”, 46.3 percent of adults with mild to moderate disabilities had unmet health care and social services needs. 47.4 percent of adults with severe to very severe disabilities had unmet health care and social services needs. The total percentage of adults with disabilities with unmet health care and social services needs due to expense is 47.0 percent.

For the section described as “do not know where/how to obtain services”, 14.6 percent of adults with mild to moderate disabilities had unmet health care and social services needs. 25.7 percent of adults with severe to very severe disabilities had unmet health care and social services needs. The total percentage of adults with disabilities with unmet health care and social services needs due to not knowing where or how to obtain services is 21.5 percent.

For the section described as “condition not severe enough” 13.0 percent of adults with mild to moderate disabilities had unmet health care and social services needs. 8.7 percent of adults with severe to very severe disabilities had unmet health care and social services needs. The total percentage of adults with disabilities with unmet health care and social services needs due to condition not severe enough is 10.3 percent.

Source: Statistics Canada, 2006 Participation and Activity Limitation Survey

Drugs and medication

Drugs and medication Footnote 12   Footnote 13 can be considered disability aids. In the same way that glasses or contact lenses enable some people with seeing disabilities to participate more fully in everyday life, medication enables people with conditions such as pain disabilities, agility disabilities or mental health disabilities to reduce barriers associated with their conditions.

Medication usage

A total of 82.2% of adults with disabilities take medication on a regular basis. Footnote 14 For the vast majority of these people (93.7%), some of the medication taken on a regular basis is prescription medication.

Regular medication usage is correlated with severity of disability. While regular usage of medication is common for all levels of severity, it is especially high for adults who have severe (89.0%) or very severe (93.1%) disabilities, as shown in Chart 2.5.

Chart 2.5: Regular medication usage by severity of disability for adults, 2006 (%)

A text description of Chart 2.5 is provided below
Chart 2.5 Text Description

This vertical bar graph illustrates regular medication usage by severity of disability for adults, 2006

The chart is divided into five sections, each section representing severity of disability. The horizontal axis lists the following categories:

  • Mild
  • Moderate
  • Severe
  • Very severe
  • Total

The vertical axis is measured by percentages and increases by increments of 10 from 0 to 100.

73.1 percent of adults with mild disabilities reported regular medication usage.

82.3 percent of adults with moderate disabilities reported regular medication usage.

89.0 percent of adults with severe disabilities reported regular medication usage.

93.1 percent of adults with very severe disabilities reported regular medication usage.

The total percentage of adults with disabilities who are regular medication users is 82.2 percent

Source: Statistics Canada, 2006 Participation and Activity Limitation Survey

Regular medication usage increases with age. Roughly half (49.4%) of youth with disabilities use medication on a regular basis, compared to 72.3% of younger working-age adults, 86.2% of older working-age adults and 92.1% of seniors.

Of those who take medication on a regular basis, seniors are more likely to take prescription medication than youth and younger working-age adults (96.8% versus 89.2%). Usage of non-prescription medication is consistent across all age groups, with about 60% taking non-prescription medication at least once a week.

Women are more likely than men to take either prescription or non-prescription medication regularly: 85.7% of women with disabilities take medication at least once a week, compared to 78.0% of men with disabilities.

An estimated 48.7% of children with disabilities take either prescription or non-prescription medication on a regular basis. For children with severe to very severe disabilities, this rate is 57.1%. Among children, age has no effect on medication usage: younger and older children with disabilities are equally likely to take medication at least once a week.

Out-of-pocket costs for medication

An estimated 68.5% of adults with disabilities who use medication on a regular basis have out-of-pocket costs associated with their medication. This percentage is consistent across different levels of disability severity and, to a lesser degree, across different age groups. The only age group that differs significantly is young adults, 51.5% of whom have out-of-pocket costs for medication. Older working-age adults have the highest average out-of-pocket expenses; among those who have out-of-pocket expenses, the average cost is $809.53.

The average amount of out-of-pocket costs differs greatly by severity of disability. Chart 2.6 reveals that average out-of-pocket expenses for both prescription and non-prescription medication among those with very severe disabilities are almost double the costs among those with mild disabilities.

Chart 2.6: Average out-of-pocket costs for regularly taken medication by severity of disability for adults who had out-of-pocket costs, 2006 ($)

A text description of Chart 2.6 is provided below
Chart 2.6 Text Description

This vertical bar graph illustrates average out-of-pocket costs for regularly taken medication by severity of disability for adults who had out-of-pocket costs, 2006.

The chart is divided into five sections, each section representing severity of disability.

The horizontal axis lists the following categories:

  • Mild
  • Moderate
  • Severe
  • Very severe
  • Total

The vertical axis is measured in dollars spent (average out-of-pocket costs) and increases in increments of 200 dollars, from 0 to 1,200 dollars.

For adults who have mild disabilities, their average out-of-pocket costs for regularly taken medication are 512.68 dollars.

For adults who have moderate disabilities, their average out-of-pocket costs for regularly taken medication are 608.87 dollars.

For adults who have severe disabilities, their average out-of-pocket costs for regularly taken medication are 736.80 dollars.

For adults who have very severe disabilities, their average out-of-pocket costs for regularly taken medication are 947.07 dollars.

The total average out-of-pocket costs for regularly taken medication, for adults with disabilities, are 672.29 dollars.

Source: Statistics Canada, 2006 Participation and Activity Limitation Survey

Nearly four out of ten parents of children with disabilities (37.3%) have out-of-pocket costs for prescription and non-prescription medication taken regularly by their children. For parents who had out-of-pocket costs in 2005–2006, the average cost was $541.31.

Many people with disabilities may have access to resources that help them pay for medication. Two common reimbursement sources are social assistance programs and private health plans. Chart 2.7 shows average out-of-pocket costs for medication by available sources of reimbursement.

Chart 2.7: Average out-of-pocket costs for regularly taken medication by reimbursement source for adults with disabilities, 2006
Reimbursement source Average Expense ($)
No reimbursement source 670.22
Only government sources 597.25
Private health insurance 760.12
Chart 2.7 Text Description

This chart describes the average out-of-pocket costs by reimbursement source for adults with a disability.

For individuals with no reimbursement source the average out-of-pocket expense is 670.22 dollars.

For individuals with only government sources, the average out-of-pocket expense is 597.25 dollars.

For individuals with private health insurance, the average out-of-pocket expense is 760.12 dollars.

Source: Statistics Canada, 2006 Participation and Activity Limitation Survey

Interestingly, those with private health insurance have higher average out-of-pocket expenses than those who have no source of reimbursement at all. Since private health insurance plans are commonly linked to employment, this could be an indication that those who do not have any available source of reimbursement may be forgoing medication because they cannot afford it.

Unmet medication needs

Overall, 527 690 adults with disabilities were unable to get medication, or had to take less medication, because of cost at least once in 2005–2006; this represents about 12.9% of adults with disabilities. Among those with very severe disabilities, this percentage is 23.8%.

Unmet needs vary by gender and age. Women are more likely than men to have unmet needs for medication due to cost (15.3% versus 10.0%). Younger working-age adults have the highest percentage of unmet needs due to cost (20.3%). In addition, 7 430 children with disabilities (3.7%) have unmet needs for medication. In over two thirds of these cases, cost is the main barrier.

Health-related aids and devices

Some people with disabilities require health-related aids and devices Footnote 15 as a direct result of their condition. Such aids include respiratory aids, pain management aids, diabetic aids, and abdominal, back or neck supports.

Respiratory aids

An estimated 68 940 adults and 6 070 children with disabilities use a respiratory aid such as a puffer or an inhaler; this represents 1.7% of people with disabilities overall. Among adults with very severe disabilities, 2.8% use a respiratory aid. Men with disabilities are slightly more likely than women to use respiratory aids (1.9% versus 1.4%).

For adults who use respiratory aids, the health care system or a government program is the most common funder: in 40.9% of cases, one of these pays the most for the aid or device, whereas the user or the user’s family assumes the bulk of the responsibility for paying for the aid 30.4% of the time, and insurance companies pay the most 22.6% of the time.

In addition, 6 570 adults and 670 children with disabilities need a respiratory aid but do not have one; this represents 0.2% of people with disabilities in Canada.

Pain management aids

A small number (19 270) of adults with disabilities (0.5%) use a pain management aid, such as a TENS machine. Footnote 16 Almost half of the users of pain management machines have very severe disabilities. Pain management machines are more commonly used among working-age adults with disabilities (0.6%) than among seniors with disabilities (0.2%). Men and women are equally likely to use pain management aids.

In 57.9% of cases, users or their families pay the majority of the cost of the pain management aid. In addition, 11 580 adults with disabilities need a pain management aid but do not have one; 73.2% of those who have unmet needs are women and 52.8% are younger working-age adults.

Diabetic aids

An estimated 59 210 Canadians with disabilities use diabetic aids, such as blood glucose monitors or needles. This number represents approximately 1.4% of adults with disabilities. The percentage is similar across age groups, gender and, to a lesser extent, severity of disability.

For 43.4% of diabetic aid purchases among adults with disabilities, the user or the user’s family pays the most. In 21.8% of cases, a government program pays the most, and in 18.3% of cases, an insurance company makes the largest contribution. The health care system is the primary contributor 8.7% of the time.

Abdominal, back or neck supports

An estimated 64 630 adults and 850 children with disabilities (1.5% of all people with disabilities) use abdominal, back or neck supports such as ergonomic cushions or support belts. Among those with very severe disabilities, this percentage is 2.6%. Usage of this type of aid is most common among youth and younger working-age adults, for whom the percentage is also 2.6%. For 85.2% of the adults with disabilities who use such aids, the user or the user’s family covers the majority of the cost.

Conclusion

Ensuring that all people with and without disabilities have access to the health care services they require is a critical part of our society’s health and well-being. All people require support from health professionals at some point in their lives. However, the statistics presented in this chapter reveal that some people with disabilities are not receiving the health care that they need due to barriers including cost and lack of information. Cost is also the largest barrier preventing people with disabilities from obtaining needed medication and other health-related aids. Unmet health care needs have far-reaching implications: ill health can interfere with education, employment and the ability to meet basic everyday needs. Understanding reasons for unmet needs helps to ensure that the proper health supports can be put in place so that people with disabilities have equal opportunities to participate fully in society.

Spotlight on programs: Enabling Accessibility Fund

Budget 2007 announced the creation of the Enabling Accessibility Fund (EAF) in the amount of $45 million over three years to assist communities with projects that improve accessibility for people with disabilities. Budget 2010 builds on the success of this program by extending the EAF and providing $45 million for an additional three years to remove barriers for Canadians with disabilities.

Budget 2010 also expands the EAF to include contribution funding in support of mid-sized projects, allowing communities to undertake larger retrofit projects or to foster partnerships for new facilities.

Through the Small Project Component of the EAF, grants may be provided in support of projects that improve the built environment through renovation, construction and retrofitting of buildings; modification of vehicles for community use; and provision of accessible information or communication technologies.

The objective of the EAF is to support community-based projects across Canada that improve accessibility and enable Canadians, regardless of physical ability, to participate in and contribute to their communities and the economy.

In 2009, the EAF funded 163 projects across Canada. To find out how to apply for financial assistance or for more information about this program, please call the EAF toll free at 1-866-268-2502.

Spotlight on the Alzheimer Society of Canada’s national bilingual online portal

Since 1978, the Alzheimer Society has provided care, support and information to people with Alzheimer’s disease and their families. In 2009, the EAF contributed $50,000 in the form of a grant to the Alzheimer Society of Canada’s national bilingual online portal to support making information and communication technologies more accessible. The portal will provide Canadians throughout the country with access to information on Alzheimer’s disease and local programs. The Alzheimer Society estimates that approximately 500 000 Canadians are currently living with Alzheimer’s disease, and it is expected that prevalence will increase by up to 50% within 5 years.

The content redevelopment and redesign will ensure that the site will meet accessibility standards and guidelines for websites. This will result in a website that is a user-friendly portal for its target group—seniors and people with Alzheimer’s disease or related dementia. The portal will have enhanced usability through improved design and offer enriched content based on user feedback. Some of the design improvements will facilitate access to important health information for people who are colour-blind, use bifocals, have attention deficit disorders or other cognitive impairments, or have challenges related to fine motor skills. The Alzheimer Society of Canada's website can be found at www.alzheimer.ca.

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