Association of Income Disparities with Patient-Reported Healthcare Experience

Victor Okunrintemi, Rohan Khera, Erica S. Spatz, Joseph A. Salami, Javier Valero-Elizondo, Haider J. Warraich, Salim S. Virani, Ron Blankstein, Michael Blaha, Timothy M. Pawlik, Kumar Dharmarajan, Harlan M. Krumholz, Khurram Nasir

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalJournal of general internal medicine
DOIs
StatePublished - Jan 1 2019

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Delivery of Health Care
Communication
Health Personnel
Quality of Health Care
Vulnerable Populations
Health Expenditures
Patient Satisfaction
Social Class
Decision Making
Retrospective Studies
Health
Population

Keywords

  • patient-reported experience
  • quality of care
  • socioeconomic disparities

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Okunrintemi, V., Khera, R., Spatz, E. S., Salami, J. A., Valero-Elizondo, J., Warraich, H. J., ... Nasir, K. (2019). Association of Income Disparities with Patient-Reported Healthcare Experience. Journal of general internal medicine. https://doi.org/10.1007/s11606-019-04848-4

Association of Income Disparities with Patient-Reported Healthcare Experience. / Okunrintemi, Victor; Khera, Rohan; Spatz, Erica S.; Salami, Joseph A.; Valero-Elizondo, Javier; Warraich, Haider J.; Virani, Salim S.; Blankstein, Ron; Blaha, Michael; Pawlik, Timothy M.; Dharmarajan, Kumar; Krumholz, Harlan M.; Nasir, Khurram.

In: Journal of general internal medicine, 01.01.2019.

Research output: Contribution to journalArticle

Okunrintemi, V, Khera, R, Spatz, ES, Salami, JA, Valero-Elizondo, J, Warraich, HJ, Virani, SS, Blankstein, R, Blaha, M, Pawlik, TM, Dharmarajan, K, Krumholz, HM & Nasir, K 2019, 'Association of Income Disparities with Patient-Reported Healthcare Experience', Journal of general internal medicine. https://doi.org/10.1007/s11606-019-04848-4
Okunrintemi, Victor ; Khera, Rohan ; Spatz, Erica S. ; Salami, Joseph A. ; Valero-Elizondo, Javier ; Warraich, Haider J. ; Virani, Salim S. ; Blankstein, Ron ; Blaha, Michael ; Pawlik, Timothy M. ; Dharmarajan, Kumar ; Krumholz, Harlan M. ; Nasir, Khurram. / Association of Income Disparities with Patient-Reported Healthcare Experience. In: Journal of general internal medicine. 2019.
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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.",
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AU - Valero-Elizondo, Javier

AU - Warraich, Haider J.

AU - Virani, Salim S.

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