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Low Income Groups
The poor are defined as people living in families whose household income falls below specific poverty thresholds. These thresholds vary by family size and composition and are updated annually by the U.S. Bureau of the Census. After falling for nearly a decade, from 2000 to 2002, the numbers of poor people in America rose from 31.6 million to 34.6 million and the poverty rate increased from 11.3% to 12.1%. Poverty varies by race and ethnicity. In 2002, 24% of blacks, 22% of Hispanics, 10% of Asians, and 10% of whites were poor13.
People with low incomes often experience worse health and are more likely to die prematurely14,15,16,17. In general, the poor have reduced access to high quality care. Income-related differences in quality of care that are independent of health insurance coverage have also been demonstrated18.
In previous chapters of this report, health care differences by income were described. These include comparisons of low income with high income groups on diabetic services (Figure 2.2); influenza vaccination (Figure 2.5); health insurance (Figure 3.1); specific source of ongoing care (Figure 3.3); patient perceptions of need (Figure 3.4); problems getting referral to a specialist (Figure 3.5); patient-provider communication (Figure 3.7); patient-provider relationship (Figure 3.8); office or outpatient visits (Figure 3.9); Medicare-covered home health care (Figure 3.11); and mental health care (Figure 3.13). Rather than repeat these findings, quality of and access to health care for the poor are summarized in this section.
In the 2003 NHDR, health care received by the poori and by high incomeii individuals was compared for a large number of measures related to quality of and access to care. In the 2004 NHDR, a subset of measures, for which comparable data are available for 2000 and 2001, are highlighted. Data on all measures were not available for the poor. Go to Tables 1.2 and 1.3 for lists of measures available for the poor and Appendix C for data on each measure for the poor.
Changes in income-related differences over these 2 years are examined. For each measure, the poor can receive care that is worse than, about the same as, or better than care received by people with high incomes. Only relative differences of at least 10% and that are statistically significant with p<0.05 are discussed in this report.
Community health centers are vital sources of health care for many low income individuals. These centers are also effective at reducing disparities; black-white disparities in overall mortality and prenatal care and Hispanic-white disparities in tuberculosis case rates and prenatal care are smaller in States with better coverage of low income persons by community health centers19. Information on quality of and access to care provided by community health centers as well as on racial, ethnic, and socioeconomic differences in CHC care is also presented in this section.
In the 2003 NHDR, the poor had lower quality of care than high income people for about two-thirds of quality measures with available data, including not receiving screening for cancer or cardiovascular risk factors and not receiving recommended childhood and adult immunizations. In the 2003 NHDR, the poor had worse access to care than high income people for about two-thirds of access measures, including lacking health insurance or a usual source of health care, having problems getting referred to a specialist, and rating their health care poorly.
In the 2004 NHDR, 38 measures of quality of health care with comparable data for 2000 and 2001 are highlighted. These measures come from SEER, USRDS, MEPS, CDC AIDS Surveillance System, NVSS-N, NIS, NHIS, and NHDS. Mortality measures from vital statistics are excluded to allow focus on quality measures more directly related to health care. In the 2004 NHDR, 31 measures of access to health care with comparable data for 2000 and 2001 are also highlighted. These measures come from MEPS and NHIS. Health care utilization measures are excluded to allow focus on measures more directly related to access to care.
Figure 4.7. Poor compared with high income individuals in 2000 and 2001 on measures of quality of care (top) and access to care (bottom)
[D] Select for Full Text Description.
[D] Select for Full Text Description.
Better = The poor receive better quality of care or have better access to care than high income people.
Same = The poor and high income people receive about the same quality of care or access to care.
Worse = The poor receive poorer quality of care or have worse access to care than high income people.
Source: MEPS, NIS, NHIS, 2000-2001.
- Of the 38 measures of quality with comparable data for 2000 and 2001, information on income was not available for 16. Of the remaining 22 measures, the poor received lower quality of care than high income individuals for about 60% of measures in both 2000 and 2001 (Figure 4.7, top).
- Between 2000 and 2001, only 1 of these 22 measures demonstrated significant improvement among different income groups: children 19-35 months who received 1 dose of varicella vaccine improved among poor children.
- Information on income was available for all 31 of the measures of access with comparable data for 2000 and 2001. The poor had worse access to care than high income individuals for over 80% of measures in both 2000 and 2001 (Figure 4.7, bottom).
- Between 2000 and 2001, 4 of the 31 measures demonstrated significant improvement among high income people while none demonstrated significant improvement among the poor. Six access measures declined among the poor compared with two measures among those with high income.
i Household income less than Federal poverty thresholds.
ii Household income 400% of Federal poverty thresholds and higher.