New Report Identifies Ways to Reduce Income-Related Healthcare Disparities

Survey of Californians finds clear communication and patient-provider connection can level the healthcare playing field

San Francisco, CA (January 7, 2014) — Vast differences in the healthcare experiences of low-income Californians versus higher income residents could be significantly reduced – and perhaps eliminated – by improving the relationship between patient and caregiver, according to a report released today by Blue Shield of California Foundation.

“The findings in this report provide new evidence that prevailing inequities in our healthcare system are not intractable,” said Peter V. Long, Ph.D., the Foundation’s president and CEO. “By identifying the factors that explain inequalities in patient satisfaction and engagement, and developing simple, achievable solutions to address those factors, we can begin to level the healthcare playing field for all Californians.”

The report, titled “Health Care in California: Leveling the Playing Field,” advocates creative, practical approaches such as enhanced patient-provider relationships, team-based care and increased use of communications technology to reduce the health-related disparities dividing low- and higher-income state residents.

Low-income individuals, in contrast to those with higher incomes, have weaker relationships with their care providers, less information and less satisfaction with their care.  Previously, it was believed that these healthcare disparities were the inevitable result of entrenched social and structural barriers. The findings in this report contradict that thinking. The new research suggests that, while income illustrates the problem, it’s the nature of the care patients receive that more strongly drives inequality.

These results reinforce findings from another recent Foundation report, “Building Better Health Care for Low-Income Californians.” This report, released in October 2013, found that clear, accessible information and open communication are key building blocks for forging strong patient-provider relationships, producing engaged patients and ultimately improving health outcomes.  The new study adds to that research by comparing results across income levels.

Key points in the “Leveling the Playing Field” report include:

  • Only 35 percent of lower-income Californians report their current health status as “excellent” or “very good,” compared with 61 percent of higher-income Californians.
  • Low-income Californians are 12 points less likely than higher-income residents to feel very informed about their health.
  • Just 38 percent of low-income Californians say someone at their care facility knows them pretty well (the definition of “connectedness”), compared with 52 percent of higher-income Californians. 
  • Less than half of low-income Californians rate the quality of their care positively, compared with 69 percent of those with higher incomes.
  • Feeling connected and well informed about one’s health significantly weakens the relationship between income and quality-of-care ratings.   Use of technology, especially e-mail and text messages, also can reduce the gap in care experiences between higher- and low-income Californians.

This research is part of a series of reports to better inform policymakers, stakeholders and providers about the healthcare needs and preferences of low-income Californians, as this group gains new access to care and coverage options under the Patient Protection and Affordable Care Act.

Full survey results are available here.

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About the Survey

Interviews were conducted in English and Spanish on landline and mobile phones from May 2-June 8, 2013. There were 1,516 respondents in the random statewide sample: 1,018 with household family incomes below 200 percent of the federal poverty level (FPL), and 498 with incomes at 200 percent or above. The study was produced and analyzed by Langer Research Associates of New York, N.Y., after an extensive review of the relevant literature and discussions with prominent researchers and practitioners in the field. The results have a margin of sampling error of plus or minus 3.5 percentage points for the low-income sample and 5 points for higher-income respondents.


About Blue Shield of California Foundation

Blue Shield of California Foundation is one of the state’s largest and most trusted grantmaking organizations. Our mission is to improve the lives of all Californians, particularly the underserved, by making health care accessible, effective, and affordable, and by ending domestic violence. For more information, visit www.blueshieldcafoundation.org.