Understanding Why Patients Of Low Socioeconomic Status Prefer Hospitals Over Ambulatory Care
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Open Access
- 1 July 2013
- journal article
- Published by Health Affairs (Project Hope) in Health Affairs
- Vol. 32 (7), 1196-1203
- https://doi.org/10.1377/hlthaff.2012.0825
Abstract
Patients with low socioeconomic status (SES) use more acute hospital care and less primary care than patients with high socioeconomic status. This low-value pattern of care use is harmful to these patients’ health and costly to the health care system. Many current policy initiatives, such as the creation of accountable care organizations, aim to improve both health outcomes and the cost-effectiveness of health services. Achieving those goals requires understanding what drives low-value health care use. We conducted qualitative interviews with forty urban low-SES patients to explore why they prefer to use hospital care. They perceive it as less expensive, more accessible, and of higher quality than ambulatory care. Efforts that focus solely on improving the quality of hospital care to reduce readmissions could, paradoxically, increase hospital use. Two different profile types emerged from our research. Patients in Profile A (five or more acute care episodes in six months) reported social dysfunction and disability. Those in Profile B (fewer than five acute care episodes in six months) reported social stability but found accessing ambulatory care to be difficult. Interventions to improve outcomes and values need to take these differences into account.Keywords
This publication has 33 references indexed in Scilit:
- Factors Affecting the Likelihood of Presentation to the Emergency Department of Trauma Patients After DischargeAnnals of Emergency Medicine, 2011
- Trends and Characteristics of US Emergency Department Visits, 1997-2007JAMA, 2010
- Contribution of Primary Care to Health Systems and HealthThe Milbank Quarterly, 2005
- Access to emergency care: Restricted by long waiting times and cost and coverage concernsAnnals of Emergency Medicine, 2004
- Comparing Uninsured and Privately Insured Hospital Patients: Admission Severity, Health Outcomes and Resource useHealth Services Management Research, 2001
- Recent Findings On Preventable HospitalizationsHealth Affairs, 1996
- Impact Of Socioeconomic Status On Hospital Use In New York CityHealth Affairs, 1993
- Perspective: The Microanatomy of Health CareHealth Affairs, 1993
- The national profile of access to medical care: where do we stand?American Journal of Public Health, 1984
- Use of Ambulatory Medical Care by the Poor: Another Look at EquityMedical Care, 1981