Affordable, Quality Healthcare Varies Due to Income, Geography

Access to affordable, quality healthcare varies greatly for low-income people based on where they live, according to a new Commonwealth Fund report scorecard.

But the wide differences in geography often put higher-income families at risk as well. The report finds that higher-income people living in states that lag far behind the top scoring states are often worse off than low-income people in states that rank at the very top of the scorecard. For example, low-income elderly Medicare beneficiaries in Connecticut and Wisconsin are less likely to receive high-risk medications than are higher-income elderly in Mississippi, Louisiana, and Alabama.

The scorecard provides the first state-by-state comparison of the healthcare experiences of the 39 percent of Americans with incomes less than 200 percent of the federal poverty level, or $47,000 a year for a family of four and $23,000 for an individual. Low-income people account for at least 25 percent of total state populations, and as much as nearly half (47 percent) in some states, including Arkansas, Louisiana, Mississippi, and New Mexico.

The report, Health Care in the Two Americas: Findings from the Scorecard on State Health System Performance for Low-Income Populations, also compares the healthcare experiences of those with low incomes to those with higher incomes — over 400 percent of poverty, or $94,000 for a family of four — and finds striking disparities by income within each state.

The report finds substantial variation in healthcare and health outcomes for low-income people—a two- to five-fold difference. While there was room for every state to improve, states in the Upper Midwest, Northeast, and Hawaii performed best, while Southern and South Central states often lagged.

Some findings of wide geographic disparities and gaps in care include:

  • The percentage of uninsured low-income adults ranged from a low of 12 percent in Massachusetts to a high of 55 percent in Texas.
  • Only 32 percent of low-income adults ages 50 or older received recommended preventive care, such as cancer screenings and vaccines, ranging from 26 percent or less in Idaho, Oklahoma, and California, to 42 percent in Massachusetts, the top-ranked state for this indicator.
  • In eight states, 40 percent or more of Medicare beneficiaries received medications considered high-risk for the elderly — rates more than double that of states with safer prescribing.
  • Asthma-related hospitalizations among children from low-income communities in New York were eight times higher than in Oregon, the state with the lowest rate: 477 per 100,000 in New York compared to 56 per 100,000 in Oregon.
  • At least one of four low-income adults under 65 in West Virginia, Tennessee, Alabama, Mississippi, and Kentucky lost six or more teeth due to decay or disease, compared to less than 10 percent in Connecticut, Hawaii, and Utah, the states with the lowest rates.

According to the scorecard, if all states could reach benchmarks set by the leading states for their more advantaged populations:

  • An estimated 86,000 fewer people would die prematurely each year,
  • An estimated 750,000 fewer low-income Medicare beneficiaries would be prescribed potentially dangerous medications,
  • Tens of millions of adults and children would receive needed preventive care like vaccines, check-ups, and cancer screenings,
  • Nearly 9 million fewer low-income adults under age 65 would lose six or more teeth because of tooth decay, infection, or gum disease, and
  • Thirty million more low-income adults and children would have health insurance coverage, reducing the number of uninsured by more than half.

Insurance and access to healthcare are closely linked: the report finds that insured low-income people have similar rates of having a usual source of care and receiving recommended care as insured high-income people. However, insurance alone doesn’t guarantee receipt of high-quality, safe care, as demonstrated by the varied experience of low- and higher-income Medicare beneficiaries, all of whom are insured.

The report findings point to the need to strengthen primary care to ensure timely access, reduce reliance on emergency rooms, and improve care for those with chronic disease. The scorecard finding that those living in low-income communities often fare worse points to the need for targeted efforts focused on “hot spots,” or communities with very high rates of hospital or emergency room use, to act early, prevent complications and improve population health.

Source: The Commonwealth Fund , September 18, 2013

Service Delivery for Vulnerable Populations, New Directions in Behavioral Health provides students and professionals in healthcare and service delivery with innovative programs and models to address the needs of vulnerable populations with such health issues as substance abuse, mental illness, and poverty.

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