Victor Okunrintemi1, Rohan Khera2, Erica S Spatz3,4, Joseph A Salami5, Javier Valero-Elizondo3, Haider J Warraich6, Salim S Virani7,8, Ron Blankstein9, Michael J Blaha10, Timothy M Pawlik11, Kumar Dharmarajan12, Harlan M Krumholz3,4, Khurram Nasir13,14. 1. Department of Internal Medicine, East Carolina University, Greenville, NC, USA. 2. Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 3. Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, USA. 4. Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA. 5. TeleHealth, eICU, Baptist Health South Florida, Miami, FL, USA. 6. Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, USA. 7. Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA. 8. Baylor College of Medicine, Houston, TX, USA. 9. Brigham and Women's Hospital, Boston, MA, USA. 10. Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA. 11. Wexner Medical Center, Ohio State University, Columbus, OH, USA. 12. Clover Health, Jersey City, NJ, USA. 13. Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, USA. khurram.nasir@yale.edu. 14. Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA. khurram.nasir@yale.edu.
Abstract
BACKGROUND: Disparities in health outcome exist among patients according to socioeconomic status. However, little is known regarding the differences in healthcare experiences across the various levels of income of patients. In a nationally representative US adult population, we evaluate the differences in healthcare experiences based on patient level of income. OBJECTIVES: To evaluate the differences in patient healthcare experiences based on level of income. PATIENTS AND METHODS: We identified 68,447 individuals (mean age, 48 ± 18 years; 55% female) representing 176.8 million US adults, who had an established healthcare provider in the 2010-2013 Medical Expenditure Panel Survey cohort. This retrospective study examined the differences in all five patient-reported healthcare experience measures (access to care, provider responsiveness, patient-provider communication, shared decision-making, and patient satisfaction) under the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. We examined the relationship between patient income and their healthcare experience. RESULTS: Overall, 32% of the study participants were high-income earners while 23% had very-low income. Lower income was consistently associated with poor patient report on healthcare experience. Compared with those with high income, very-low-income-earning participants had 1.63 times greater odds (OR 1.63, 95% CI 1.45-1.82) of experiencing difficulty accessing care, had 1.34 times higher odds (OR 1.34, 95% CI 1.25-1.45) of experiencing poor communication, had higher odds (OR 1.68, 95% CI 1.46-1.92) of experiencing delays in healthcare delivery, and were more likely to report poor provider satisfaction (OR 1.48, 95% CI 1.37-1.61). CONCLUSION: Lower income-earning patients have poorer healthcare experience in all aspects of access and quality of care. Targeted policies focusing on improving communication, engagement, and satisfaction are needed to enhance patient healthcare experience for this vulnerable population.
BACKGROUND: Disparities in health outcome exist among patients according to socioeconomic status. However, little is known regarding the differences in healthcare experiences across the various levels of income of patients. In a nationally representative US adult population, we evaluate the differences in healthcare experiences based on patient level of income. OBJECTIVES: To evaluate the differences in patient healthcare experiences based on level of income. PATIENTS AND METHODS: We identified 68,447 individuals (mean age, 48 ± 18 years; 55% female) representing 176.8 million US adults, who had an established healthcare provider in the 2010-2013 Medical Expenditure Panel Survey cohort. This retrospective study examined the differences in all five patient-reported healthcare experience measures (access to care, provider responsiveness, patient-provider communication, shared decision-making, and patient satisfaction) under the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. We examined the relationship between patient income and their healthcare experience. RESULTS: Overall, 32% of the study participants were high-income earners while 23% had very-low income. Lower income was consistently associated with poor patient report on healthcare experience. Compared with those with high income, very-low-income-earning participants had 1.63 times greater odds (OR 1.63, 95% CI 1.45-1.82) of experiencing difficulty accessing care, had 1.34 times higher odds (OR 1.34, 95% CI 1.25-1.45) of experiencing poor communication, had higher odds (OR 1.68, 95% CI 1.46-1.92) of experiencing delays in healthcare delivery, and were more likely to report poor provider satisfaction (OR 1.48, 95% CI 1.37-1.61). CONCLUSION: Lower income-earning patients have poorer healthcare experience in all aspects of access and quality of care. Targeted policies focusing on improving communication, engagement, and satisfaction are needed to enhance patient healthcare experience for this vulnerable population.
Entities:
Keywords:
patient-reported experience; quality of care; socioeconomic disparities
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