Low Socioeconomic Status

and Access to Health Care

NURS 250
Ferris State University
Katie M, Jamie W, Chris H, Courtney L

Population: Low socioeconomic Status

Education
Less than high school diploma, high school diploma, some
college, bachelors degree or higher

Income
Poverty Levels
100%, 200%, 300%, 400%
Continuum
How do these predictors affect behavior and
health?

How are low SES clients vulnerable?

Studies have shown people of lower SES have poorer health
outcomes
Reduced access to care
Lack of reliable transportation, ability to pay for copay
Underuse of recommended preventive care
Knowledge deficit
Psychological distress
Financial stress, living arrangements

Health Risk Factors

Diet
Stress levels associated with financial struggles
Sleep health
Lack of preventive care
Substance abuse
Transportation
Disabilities
Decrease in ADLs
Geographical constraints
Living in rural areas vs. urban
About 19% of Americans live in rural areas
Only 11% of physicians in America practice in rural
settings

Impacts of SES on Overall Health

According to the Health Care Disparities Report 2013:
People from the lowest SES groups are 2.5 times more likely to have
repeat emergency department visits and 2.7 times more likely to
have repeat hospitalizations within a year
Poor individuals had worse care than high-income individuals in
relation to preventative care for children, diabetes care, asthma
care, obesity prevention, patient safety and access to care
Poorer overall health and higher rates of comorbidities for lowincome individuals
Poor, low-income children are less likely than high-income children
to have a dental visit

Impacts of SES on Overall Health (contd)

According to the Health Care Disparities Report 2013:
Children from high-income households were more likely to receive all
recommended vaccinations than those of low-income households
Uninsured children were less likely to have a well-child visit than
children with private or public insurance
Poor and low-income adults were more likely than high-income
adults to report poor communication with healthcare providers

Adults from poor households were less likely to spend half an hour or
more engaged in moderate or vigorous physical activity compared
with those from high-income households

Study 1: Influence of Patients Socioeconomic

Status on Clinical Management
Qualitative study
Gain insight from physician perception of SES
Factors associated with SES that influence patient care management
Variety of clinical settings
Community care, private offices, VA, ambulatory care
Negative descriptors
Distrustful, noncompliant
Positive descriptors
Appreciative, interested in health
Physicians faced personal and financial strain caring for patients of
lower SES
Care differed with high SES vs low SES
Surprisingly no difference in outcomes

Challenges Physicians Face Today with Low SES

Patients
Strain on Physicians
Tension
Maintaining consistency of standards of care for all patients based
on their SES
Do not want to portray giving lower quality of care
Working harder
Put extra time into obtaining free medications
Finding other Physicians to provide care
Altering care
Hiring more staff to help low SES patients navigate and understand
the health care system
Cost
Could no longer afford to accept new Medicaid or uninsured
patients
Question the sustainability of their practice
Paying staff and utility bills
Delivery of healthcare differs- outcomes remain the same
Compensation

Study 2: Socioeconomic Status in Relation to

Access of Primary Health Care
Audit Study

Are people of higher SES more likely to be offered an appointment?

Clinical settings audited
Data was recorded from 375 applicable Primary Care Offices
Appointment Criteria
High SES with and without chronic conditions (diabetes)
Low SES with and without chronic conditions (diabetes)
What the Audit found
High SES had a 22.6% of being offered an appointment
Low SES had a 14.3% of being offered an appointment
High SES without chronic condition 15.9%
High SES with chronic condition 28.6%

Low SES without chronic condition 9.9%

Study 3 - Primary Care Access,

by Rhodes & colleagues

Investigated primary care access for new patients as related to

payment type & amount
Ability to schedule appointment correlated with type/amount of
payment
Insured patient-callers:
84.7% privately insured callers secured an appointment
57.9% of Medicaid clients

Uninsured patient-callers:
78.8% making full cash payment at visit, but
15.4% if payment at visit was restricted to $75 or less
In areas like Michigan where primary care providers are already limited,
imagine how Medicaid client access might be affected?

Self-Care Theory, Dorothea Orem

(Everyone has needs and, potentially, unmet needs)

Clients with low SES sometimes lack resources to meet

healthcare needs
With resources provided, low SES clients can become
empowered
Health-promotion activities of Needs Theory (Maville &
Huerta, 2013, p.33):
Knowledge-seeking actions
Assistance if necessary
Resource-using actions

Healthy people 2020

Disparity: Health outcome is greater or lesser for a group of people
Poorer health outcomes among people of low socioeconomic status
(SES)
Healthy People 2020 aims to eliminate all disparities:
Achieve health equity, eliminate disparities, and improve the
health of all groups.
Improving health outcomes for people of low SES directly relates to

Plan of action to address Poor Access

Encourage universities nationwide to incorporate public health services
Provided by students
Predetermined dates
Role of the universities and education institutions
Implement public health care into college health curriculums

How this benefits everyone

Provides students in health care curriculums valuable experience
Delivers affordable health services to anyone in need
Program Benefits
Creates a friendly environment for health promotion and education
Connects university with community
Smaller more manageable version of a free clinic

Implementation of Action Plan

Each university in Michigan would offer clinic hours on predetermined dates
Every first and fourth Friday of the month
Services provided
Routine check ups
Health assessments
Blood pressure screening
Education on a wide variety of health issues
Counseling
Students provide services
Overseen by instructors-who are licensed
Opportunity to perfect skills

Concerns
Liability
Financial support for supplies
Community members availability

Our Roles as Future Nurses

Theory Driven
Meeting unmet needs
Working toward common goal
Eliminate Health Disparities
Promote health for people in all groups
Challenge yourself
Be creative with care
Be part of the solution
Compensate when necessary to ensure outcomes are the same
Educate
Provide material on the appropriate education level
Provide additional resources

References
About Healthy People. Healthy People 2020. Retrieved from http://www.healthypeople.gov/2020/
about/default.aspx
Bernheim, S., Ross, J., Krumholz, H., & Bradley, E. (2008). Influence of patients' socioeconomic status
on clinical management decisions: A qualitative study. Annals Of Family Medicine, 6(1), 53-59.
Maville, J. & Huerta, C. (2013). Health promotion in nursing (3rd ed.). Clifton Park, NY: Delmar.
Olah, M., Gaisano, G., & Hwang, S. (2013). The effect of socioeconomic status on access to primary
care: An audit study. CMAJ: Canadian Medical Association Journal, 185(6), E263-9. doi:10.1503
/cmaj.121383
Rhodes, K., Kenney, G., Friedman, A., Saloner, B., Lawson, C., Chearo, D., & ... Polsky, D. (2014).
Primary care access for new patients on the eve of health care reform. JAMA Internal Medicine,
174(6), 861-869. doi:10.1001/jamainternmed.2014.20
Saydah, S., Imperatore, G., & Beckles, G. (2013). Socioeconomic status and mortality: Contribution of
health care access and psychological distress among U.S. adults with diagnosed diabetes.
Diabetes Care, 36(1), 49-55. doi:10.2337/dc11-1864 1935-5548
U.S. Department of Health and Human Services. Agency for Healthcare Research and Quality. (2014).
2013 National healthcare disparities report (AHRQ Publication No. 14-0006). Washington, DC:
U.S. Government Printing Office.
Wharam, J., Fang, Z., Landon, B., Soumerai, S., & Ross-Degnan, D. (2013). Low-socioeconomic-status
enrollees in high-deductible plans reduced high-severity emergency care. Health Affairs, 32(8),
1398-1406. doi:10.1377/hlthaff.2012.1426