Unmet Healthcare Needs Among People with Disabilities—a Policy and Practice Analysis

Background and Purpose

Access to quality healthcare remains a critical challenge for people with disabilities, who often face systemic barriers leading to unmet medical needs. Despite policy advancements aimed at improving access, disparities persist, disproportionately affecting individuals with complex conditions, lower incomes, and marginalized identities. This study utilizes data from the 2023/2024 National Survey on Health and Disability (NSHD) to examine the prevalence of unmet healthcare needs among adults with disabilities and their impact on health outcomes. Through a social justice lens, the study investigates how insurance status, disability type, and socioeconomic factors contribute to healthcare inequities, emphasizing the implications for policy and social work practice.

Methods

This study employs secondary data analysis of the 2023/2024 NSHD dataset (n=1,919), comprising responses from a diverse population of adults with disabilities across the United States. The dataset captures various disability categories, including physical impairments, chronic conditions, sensory disabilities, and mental health disorders. Using multivariate regression models, we examine the relationship between demographic factors (i.e., age, gender, race/ethnicity, income level, and education), disability characteristics (i.e., type, age of onset, and severity), and insurance status with self-reported unmet healthcare needs. These needs encompass primary care, specialty services, mental health treatment, prescription medications, and access to durable medical equipment. A qualitative analysis of open-ended survey responses further contextualizes the barriers faced by individuals experiencing unmet needs.

Results

Preliminary analysis indicates that 43% of respondents reported experiencing at least one unmet healthcare need within the past year. Insurance status emerged as a significant predictor, with uninsured individuals demonstrating markedly higher unmet needs across all service categories. Notably, 37% of insured participants still reported barriers to healthcare access, citing limitations in provider networks, high out-of-pocket costs, and restrictive insurance policies. The most frequently reported unmet needs were for mental health services (52%) and specialty care (48%). Disparities were particularly pronounced among individuals with multiple disabilities and those from racial/ethnic minority backgrounds, who reported disproportionately higher rates of unmet needs. Moreover, respondents experiencing unmet healthcare needs were 2.3 times more likely to report deteriorating physical health and 2.7 times more likely to experience worsening mental health.

Conclusions and Implications

Findings highlight persistent structural barriers within the U.S. healthcare system, which continue to marginalize people with disabilities despite existing policy efforts. Addressing these gaps requires comprehensive policy interventions, including the expansion of Medicaid eligibility, enhanced provider network adequacy regulations, reductions in cost-sharing for essential healthcare services, and the implementation of disability cultural competency training for healthcare providers. Social workers are uniquely positioned to spearhead transformative change by advocating for these policy reforms, developing innovative service models, and ensuring that the lived experiences of people with disabilities inform both research priorities and practice interventions. By bridging the gap between research, policy, and practice, social work can play a pivotal role in advancing health equity and improving outcomes for people with disabilities.