RESUMO
State prescription drug monitoring programs (PDMPs) use proprietary, predictive software platforms that deploy algorithms to determine whether a patient is at risk for drug misuse, drug diversion, doctor shopping, or substance use disorder (SUD). Clinical overreliance on PDMP algorithm-generated information and risk scores motivates clinicians to refuse to treat-or to inappropriately treat-vulnerable people based on actual, perceived, or past SUDs, chronic pain conditions, or other disabilities. This essay provides a framework for challenging PDMP algorithmic discrimination as disability discrimination under federal antidiscrimination laws, including a new proposed rule interpreting section 1557 of the Affordable Care Act.
Assuntos
Morfolinas , Uso Indevido de Medicamentos sob Prescrição , Estados Unidos , Humanos , Capacitismo , Patient Protection and Affordable Care Act , AlgoritmosRESUMO
State Medical Boards (SMBs) can take severe disciplinary actions (e.g., license revocation or suspension) against physicians who commit egregious wrongdoing in order to protect the public. However, there is noteworthy variability in the extent to which SMBs impose severe disciplinary action. In this manuscript, we present and synthesize a subset of 11 recommendations based on findings from our team's larger consensus-building project that identified a list of 56 policies and legal provisions SMBs can use to better protect patients from egregious wrongdoing by physicians.
Assuntos
Médicos , Má Conduta Profissional , Humanos , Licenciamento em MedicinaRESUMO
For almost fifty years, federal civil rights laws such as Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act (ADA) of 1990 and the ADA Amendments Act of 2008, and Section 1557 and other provisions of the 2010 Patient Protection and Affordable Care Act have prohibited discrimination against Americans with disabilities, including in health care. Despite these laws, disabled Americans continue to experience disparities in health and health care, from preventive care to home and community-based services. In its 2022 Health Equity Framework for People with Disabilities, the National Council on Disability highlighted some of these disparities and recommended remedies. To explore these concerns, this article examines disability inequities and potential solutions within six areas. It concludes by recommending the ratification of the 2006 United Nations Convention on the Rights of Persons with Disabilities to reinvigorate US efforts to maximize the health and dignity of disabled Americans and support their full participation in the community.
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Pessoas com Deficiência , Patient Protection and Affordable Care Act , Direitos Civis , Atenção à Saúde , Humanos , Nações Unidas , Estados UnidosRESUMO
This article examines the unique disadvantages experienced by Black people and other people of color with substance use disorder in health care, and argues that an intersectional approach to enforcing disability rights laws offer an opportunity to ameliorate some of the harms of oppression to this population.
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Pessoas com Deficiência , Racismo , Transtornos Relacionados ao Uso de Substâncias , População Negra , Atenção à Saúde , HumanosRESUMO
More than thirty years since the enactment of the Americans with Disabilities Act (ADA), people with disability continue to experience health care disparities. The ADA mandates that patients with disability receive reasonable accommodations. In our survey of 714 US physicians in outpatient practices, 35.8 percent reported knowing little or nothing about their legal responsibilities under the ADA, 71.2 percent answered incorrectly about who determines reasonable accommodations, 20.5 percent did not correctly identify who pays for these accommodations, and 68.4 felt that they were at risk for ADA lawsuits. Physicians who felt that lack of formal education or training was a moderate or large barrier to caring for patients with disability were more likely to report little or no knowledge of their responsibilities under the law and were more likely to believe that they were at risk for an ADA lawsuit. To achieve equitable care and social justice for patients with disability, considerable improvements are needed to educate physicians and make health care delivery systems more accessible and accommodating.
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Pessoas com Deficiência , Médicos , Instalações de Saúde , Disparidades em Assistência à Saúde , Humanos , Justiça Social , Estados UnidosRESUMO
People with disabilities are often denied equal access to organ transplantation despite long-standing federal nondiscrimination mandates. Under the Americans with Disabilities Act and the Rehabilitation Act, people cannot be excluded from consideration for organ transplantation because of disability itself, or because of stereotypes or assumptions about the value or quality of life with a disability. Instead, decisions concerning whether an individual is a candidate for organ transplantation should be based on an individualized assessment of the patient and on objective medical evidence. Recent legal developments underscore these basic guarantees and signal a new focus on the policies, practices, and attitudes that continue to compromise equal access to life-saving organ transplants for people with disabilities.
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Pessoas com Deficiência , Transplante de Órgãos , Humanos , Políticas , Qualidade de Vida , Estados UnidosAssuntos
Pessoas com Deficiência , Atenção à Saúde , Instalações de Saúde , Humanos , Estados Unidos , VacinaçãoRESUMO
This symposium includes twelve personal narratives from patients and their caregivers who have navigated challenges in planning for discharge from the hospital and transition to care at home, a rehabilitation facility, long-term care facility, or hospice. Three commentaries on these narratives are also included, authored by experts and scholars in the fields of medicine, bioethics, and health policy with particular interest in vulnerable populations. The goal of this symposium is to call attention to the experiences of patients during transitions in care and to enrich discussions of ethical issues in discharge planning.
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Ética , Alta do Paciente , Transferência de Pacientes , Autoria , Humanos , Publicações Periódicas como AssuntoRESUMO
BACKGROUND: Women with intellectual disability experience disparities in sexual and reproductive health care services. METHODS: To explore perceptions of caring for persons with disability, including individuals with intellectual disability, we conducted open-ended individual interviews with 20 practicing physicians and three video-based focus group interviews with an additional 22 practicing physicians, which reached data saturation. Interviews were transcribed verbatim. We used conventional content analysis methods to analyse transcripts. RESULT: Physicians indicated that intellectual disability can pose challenges to providing sexual and reproductive health care. Observations coalesced around four themes: (1) communication; (2) routine preventive care; (3) contraception and sterilization; and (4) conception and parenthood. Observations raised concerns about equity of access to reproductive care for women with intellectual disability. CONCLUSIONS: In our sample of physicians, we found attitudes that might compromise reproductive care for women with intellectual disability, suggesting that gaps remain in ensuring reproductive rights of women with intellectual disability.
RESUMO
Disability civil rights laws require equitable treatment of the approximately sixty-one million Americans with disability. However, federal reports and numerous research studies indicate that this diverse and growing population often experiences health care disparities. To examine one possible contributing factor, we interviewed practicing physicians to explore their knowledge of their obligations to accommodate patients with disability under federal civil rights law. Interviewees reported having had little formal training about, and demonstrated superficial or incorrect understanding of, their obligations in three potentially problematic areas: deciding which accommodations their practices should implement, refusing patients with disability, and holding patients accountable for costs of accommodations. The fact that practicing physicians might not fully understand their legal responsibilities when caring for people with disability may contribute to persisting inequity in their care, and it suggests that further education in the Americans with Disabilities Act and other disability civil rights laws may be warranted.
Assuntos
Direitos Civis/legislação & jurisprudência , Pessoas com Deficiência/legislação & jurisprudência , Conhecimentos, Atitudes e Prática em Saúde , Disparidades em Assistência à Saúde/organização & administração , Jurisprudência , Padrões de Prática Médica/legislação & jurisprudência , Avaliação da Deficiência , Feminino , Humanos , Entrevistas como Assunto , Masculino , Assistência ao Paciente/métodos , Responsabilidade Social , Estados UnidosAssuntos
Equipamentos para Diagnóstico/normas , Pessoas com Deficiência/legislação & jurisprudência , Regulamentação Governamental , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/normas , Humanos , Patient Protection and Affordable Care Act , Estados Unidos , United States Government AgenciesAssuntos
Pessoas com Deficiência , Disparidades em Assistência à Saúde , Saúde Pública , Pessoas com Deficiência/legislação & jurisprudência , Disparidades em Assistência à Saúde/legislação & jurisprudência , Disparidades em Assistência à Saúde/tendências , Humanos , Patient Protection and Affordable Care Act , Saúde Pública/legislação & jurisprudência , Saúde Pública/tendências , Estados UnidosAssuntos
Acessibilidade Arquitetônica/legislação & jurisprudência , Direitos Civis/legislação & jurisprudência , Defesa do Consumidor/legislação & jurisprudência , Pessoas com Deficiência/legislação & jurisprudência , Advogados/educação , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Humanos , Estados UnidosAssuntos
Doença Crônica , Emprego , Reforma dos Serviços de Saúde , Cobertura do Seguro , Seguro Saúde , Humanos , Estados Unidos , Local de TrabalhoRESUMO
Several recent films have villainized the health-insurance industry as a central element of their plots. This Article examines three of those films: Critical Care, The Rainmaker, and John Q. It analyzes these films through the context of the consumer backlash against managed care that began in the 1990s and shows how these films reflect the consumer sentiment regarding health-insurance companies and the cost controlling strategies they employ. In addition, the Article identifies three key premises about health insurance in the films that, although exaggerated and incomplete, have significant factual support. Ultimately, the author argues that, despite their passionately critical and liberal tone, these films actually put forward solutions that are highly individualist and conservative, rather than inclusive and systemic.