“Money is not the only answer, but it makes a difference.” —Former President Barack Obama
Wealth influences your education, your environment, and most of all, your health.
In the U.S., life expectancy is tied to income, and wealthier Americans have an advantage. The wealthier live longer than their low-income counterparts. Because of social circumstances, low-income Americans experience more stress, mental illness, violence, and obesity, among other burdens. Many low-income individuals also struggle to afford medication, lack awareness on where or when to seek care, and do not have the same access to treat and prevent their health issues.
The Affordable Care Act expanded insurance coverage to address this inequality, but gaps still persist.
People with health insurance theoretically should be using the health care system in the same manner, but this is not the case. A recent study found low-wage workers with health insurance through their employer were much more likely to go to the emergency department or be admitted to the hospital for conditions that could have been prevented compared to their higher-income colleagues. Low-wage employees were also much less likely to receive preventive care such as colonoscopies and mammograms, even though many of these services are available without any out-of-pocket expenses.
Even with expanded insurance coverage, finances play a factor. Deductibles and out-of-pocket expenses can still hinder someone from receiving care, especially if they are concerned with paying for living expenses. They are forced to make a decision between preventative care and necessities.
Beyond the cost associated with receiving care, another issue compounding the gap is the perceived stigma of low-income patients. Many patients have felt that their medical concerns were downplayed and they were treated with less respect because of their income and race. For some, this has led to a general distrust of the health care system, preventing individuals from receiving care.
Not seeking care at the appropriate time, whether because of finances or personal views, has led to disjointed health care for low-income communities and more associated health care costs. While the ACA has brought improvements, more needs to be done and will require providers, payers, and public health agencies to work together.
Organizations that have coordinated care with other providers and social services agencies have made strides at addressing the disparity. Take for instance the 10th Decile Project. It’s a partnership of health centers, hospitals, and homeless service providers in Los Angeles. Through the program, hospitals identify the 10% of patients who are homeless and have the highest associated costs and then place these individuals in permanent supportive housing. The result was a 72% reduction in total health care costs and a positive rate of return on every dollar invested.
Another example where collaboration has made an impact to support the low-income communities is the Family Van. This mobile clinic run by Harvard Medical School in partnership with health care provider organizations increases access to health care for residents in Boston’s most under-served communities. With a staff of health educators, HIV counselors, and registered dieticians, the Family Van meets individuals in their communities and provides curbside testing, coaching, and care referrals to reduce health disparities. Since the organization’s inception, the van has made more than 100,000 visits to patients.
Fixing income inequality is a complex issue that isn’t going to be solved overnight, and coverage alone will not achieve health equity. To improve health outcomes, we must address the social determinants of care by working collaboratively with community groups.
At Healthify, we are focused on coordinating services for low-income populations in order to better address the social determinants of health. If you’re interested in learning how, please contact us below!