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Why Do Poor People Prefer Hospitals Over Ambulatory Care?

Authors say barriers to care drive the poor toward ERs (July 8)

According to a new study published in Health Affairs, barriers for poor people seeking health care are leading them away from preventive doctor visits and toward emergency rooms and costly hospital-based care.

Researchers interviewed 40 patients of low socioeconomic status to document how and where they receive health care. The patients fell into two groups: socially dysfunctional or disabled patients who sought hospital care five or more times a month, and those who were socially stable but found it hard to access ambulatory care. The researchers identified the study subjects by their zip codes and hospital usage.

Common themes driving the group to hospitals included how they perceived their ability to pay for care, location of facilities, and the availability of treatment based on their schedules.

“Transportation is hard,” said one respondent.

Another woman said she and her husband were treated for years at “a wellness center,” but their high blood pressure was not treated aggressively or brought under control. “I went to the hospital, and they had it under control in four days,” she told researchers.

Lead author Dr. Shreya Kangovi said the study was meant to inform efforts to create a more efficient health care system.

Measuring readmissions, for example, is one way that the government currently gauges hospital efficiency by tracking when patients need to return to the hospital within 30 days. But the new study, Kangovi said, could shed light on other factors keeping hospital beds full, such as patient preference and perceptions of quality care.

Some programs are tackling the problems of low-income patients and primary care directly.

“An ER is not preventive. It’s not a good system for continuous care,” said Vincent Keane, CEO of Unity Health Care Inc., which includes about 30 community health clinics in the Washington, D.C. metropolitan area.

As part of Unity’s goal of serving marginalized communities, the health system started a program to divert frequent emergency users to a clinical setting. They employ social workers, regular wellness visits, and testing in an effort to provide long-term care.

For patients such as those interviewed in the Health Affairs study, and for health care reformers looking to control hospital costs, these new models could be the answer for patients getting lost in the health care system, the authors say.

Sources: Kaiser Family Foundation; July 8, 2013; and Health Affairs; July 2013.

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