Abstract
Iezzoni LI. The canary in the mine. Arch Phys Med Rehabil 2002;83:1476-8. Many Americans
are concerned about their access to health care in the future, especially their ability
to pay for needed services. However, a person with a disabling condition requiring
ongoing clinical vigilance, supportive care, and other assistive services or technologies
faces special difficulties: that person is the “canary in the mine,” warning others
about fundamental problems within our health care system. Persons with disabilities
who have health insurance are often unable to get items and services not covered by
their plans. They experience more problems than others with follow-up care, availability
of specialists, getting to doctors, and obtaining help during off hours. These problems
suggest that people with disabilities fall into the “quality chasm,” the metaphor
used by the Institute of Medicine to describe the gap between ideal care and current
reality. The Crossing the Quality Chasm report suggests 6 aims for fundamental reform, exhorting the health care system to
become safe, effective, patient-centered, timely, efficient, and equitable. Each of
these aims holds special resonance for persons with disabilities. Despite the compelling
need to overhaul the health care system, the American public as yet seems little inclined
to fundamental change. Perhaps the impetus must come from subgroups within the population
who are particularly at risk from the current system, such as persons with disabilities.
As solutions are crafted, people with disabilities, their families, and communities
should help design and direct fundamental changes to the health care system. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy
of Physical Medicine and Rehabilitation
Keywords
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Article Info
Footnotes
☆No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.
☆☆Reprint requests to Lisa Iezzoni, MD, MSc, Div of General Medicine and Primary Care, Dept of Medicine, Beth Israel Deaconess Medical Center, East Campus, 330 Brookline Ave, Boston, MA 02215, e-mail: [email protected] .
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Copyright
© 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
