Researchers Look At Why Poor Patients Prefer Hospital Care

Long wait times, jammed schedules, confusing insurance plans – there’s no shortage of obstacles between a patient and her doctor. That is, if she has a doctor.

But a Health Affairs study published Monday says the barriers for poor people looking to get care are even higher, and it’s leading them away from preventive doctor visits and toward emergency rooms and costly, hospital-based care.

“This was like holding up a magnifying lens to the problems of our health care system,” said Dr. Shreya Kangovi, lead author and a physician at the Philadelphia Veterans Affairs Medical Center.

Researchers interviewed 40 patients of low socioeconomic status in the qualitative study 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.

The study found that common themes driving the group to hospitals included how they perceived their ability to pay for care, location of facilities and 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.

Kangovi said the study was meant to inform the 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 study, Kangovi said, could shed light on other factors keeping hospital beds full, like 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 across the D.C. metropolitan area.

As part of Unity’s goal of serving marginalized communities, the health system started a program supported by Blue Cross Blue Shield 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 like those interviewed in the study, and the health care reformers looking to rein in hospital costs, these new models could be the answer for patients getting lost in the health care system.

“It’s not that patients have the wrong perception – they are the ones educating us that these are the results our system is producing,” Kangovi said.