How can a patient’s socioeconomic background affect the care we provide, or they choose?
The relationship between social-economic status (SES) and health care is quite complex. Existing studies confirm that socioeconomic status indeed affects an individual’s health care outcomes and the care they receive. The three main components of SES include education, income, and occupation. Other characteristics of SES that impact health care include insurance status, health care beliefs, access to health, and many other aspects of doctor-patient relationships like communication and trust.
Whichever aspect is reflected, whether assessed by income or education levels, low socioeconomic status has been associated with a wide range of health problems. People in the lower SES group tend to have worse self-reported health problems, including a higher prevalence of chronic illnesses like low birth weight, cardiovascular diseases, arthritis, cancer, diabetes, and hypertension. The mortality rates are also significantly higher among this group of the population compared to those of higher SES.
For instance, income levels are directly related to the type of lifestyle that a person leads. People with higher incomes can access high-end insurance covers, better nutrition, housing, and recreation. On the other hand, people in the low-income group mostly depend on public healthcare and often live in deplorable conditions that often affect their health. Patients with low incomes also use more acute health care and less primary care compared to people with higher incomes. Such decisions may be detrimental to these patients’ health.
The socioeconomic status of a patient also affects how clinicians perceive patients. Studies show that a physician is less likely to perceive people from low SES as intelligent, understanding, or rational. They view them as less responsible and less likely to adhere to medical advice, including precautions and follow up visits. These perceptions have been shown to impact the physician’s decision-making process, particularly how they deliver care.
For instance, physicians often delay diagnostic testing and prescribe more generic medications to a patient with low SES. They also avoid referring them to professional and more specialized care compared to patients in high SES. Such physicians believe that tailoring care options to the socioeconomic status of a patient can help improve their compliance, which will positively impact their health outcomes. However, studies also suggest that low socioeconomic status is a major barrier to patients because it limits them from accessing quality care, worsening their health outcomes. Physicians also tend to show less interest and effort when caring for patients with publicly financed insurances because of low reimbursement rates.
Arpey, Nicholas C., Anne H. Gaglioti, and Marcy E. Rosenbaum. “How socioeconomic status affects patient perceptions of health care: a qualitative study.” Journal of Primary Care & Community Health 8.3 (2017): 169-175.
Ohlson, Madeline. “Effects of Socioeconomic Status and Race on Access to Healthcare in the United States.” Perspectives 12.1 (2020): 2.
Van Hecke, Ann, et al. “Systematic literature review on effectiveness of self‐management support interventions in patients with chronic conditions and low socioeconomic status.” Journal of advanced nursing 73.4 (2017): 775-793.