Market

Costs factors included premiums and deductibles, hidden and out-of-pocket costs. Accessibility included accessibility of physician' office, the availability of a low examining table, out-of-area coverage, no pre-existing condition restrictions, and the availability of the primary care physician. Adequacy factors included the availability of competent resources and equipment; coverage for durable medical equipment (especially wheelchairs, protheses, and orthotics) alternative care (e.g., acupuncture, chiropractic), and emergency coverage for durable medical equipment; and variety of other services such as preventive care, psychiatric care, and attendant care. Those individuals whose disability occurred as a result of a work injury, or who incurred another injury while on the job, were highly critical of the inadequate way health plans handle workers' compensation claims. Attendant care, considered by many disability experts to be the cornerstone of maintaining one's functional capacity, was not afforded a high rank by many participants. While they frequently or continuously required personal assistance, many participants simply assumed that health care plan are not responsible for this kind of care. Quality of Care factors covered many of the same factors identified in the literature including continuity of care, timeliness, respect and courtesy, accuracy of information, etc. What may distinguish these participants for other non-disabled consumers is the urgency of factors like quickness of assessment, waiting, delays in obtaining durable medical equipment, the physician's expertise in the specific disability, and the doctor's ability to listen to the consumer (if the doctor is not familiar with the disability). More than a few participants articulated that it was just as important that the primary care physician understood health problems like respiratory illnesses that it was for she/he to be an expert in a particular condition such as muscular dystrophy. Other Factors mentioned by our participants included reputation/prestige, open-mindedness and flexibility of professional staff, problems with getting approval/referral especially for basic needs such as durable medical equipment. Many people agreed with the sentiment the best health care plan is "a plan where you don't have to fight." As other research indicates, participant attitudes toward there own health care took on an air of negativity as the discussion focused on specific instances of care. One horror story begat another. In two groups, participants seemed divided between those who viewed these negative anecdotes as exceptions, and those who believed they are representative of the plan. One woman characterized her plan as "horrible" with respect to the treatment she received for her brain injury, and wonderful when it can to diagnosing and treating her breast cancer. For a problem that any women might have, treatment was very competent and gracious; for a disability, especially one often perceived as resulting from irresponsible behavior, treatment was disorganized and decidedly ungracious.