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Researchers Look At Why Poor Patients Prefer Hospital Care

By Ankita Rao

July 8th, 2013, 5:30 PM

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.

29 Responses to “Researchers Look At Why Poor Patients Prefer Hospital Care”

  1. Steven Watkins says:

    PS. My bonus last year was zero. Matter of fact, I took a 10% cut in pay because I learned in the US Marine Corp that, “Officers Eat Last”.

  2. Isabelle says:

    No bonus? Obviously, you are joking. Are we expected to believe that? If that’s true and you didn’t get a bonus, you may want to begin a job search. Most hospital CEO’s get rewarded if they show volume and growth. Doesn’t your board reward you for volume and growth?

    http://www.kaiserhealthnews.org/stories/2013/june/06/hospital-ceo-compensation-mainbar.aspx

  3. Sharon says:

    Officers Eat Last? Is that your business plan? Is that what you tell your Board of Directors? Is that your hospitals mission statement?

  4. raul says:

    Richard. Where’s your hospital located? Is it that hude medical center in Afognak, Alaska?

  5. raul says:

    “Richard. Where’s your hospital located? Is it that hude medical center in Afognak, Alaska?”

    Meant to say…

    Steven. Where’s your hospital located? Is it that huge medical center in Afognak, Alaska?

  6. Sharon says:

    Seems like things got real quiet when they were asked for their hospital information so we could do some serious fact-checking about their financials, huh? Funny how Republicans never want to let you see “both” sets of books, huh? Reminds me of Mitt Romney not letting us see all of his tax returns, huh? Anyway, I think Beanie & Cecil scared them away, huh? Bottom line, as much as they whine and cry about reimbursements, Medicaid and Medicare pays hospitals much better than the uninsured do and most hospitals with an ounce of common sense will accept it!

  7. MP Seaman says:

    Sharon,

    If fact, officers do eat last. In this way, the enlisted personnel who do most of the ground work are taken care of so the mission can continue. I do not see this as the partisan statement you have made it out to be.

    MPS

  8. Grace Vega says:

    I, too, have worked in healthcare for many years. I am well aware of the economic complexities of our healthcare system and the serious budgetary issues faced by systems of all sizes, both rural and urban. And yes, use of the ER (referred to as ED or “Emergency Department by some) for issues more appropriately and efficiently handled by a PPO have frustrated me as well over the years. I won’t claim to have the answers for all of the problems nor would I try to address them here if I did. I would say that neither party has a very clear understanding of the issues faced by any of us who pull down less than a grand or two a year. However I, too, am interested in knowing the name of the hospital for which Mr. Watkins works in order to be sure that I never end up there in the event of planned or unplanned healthcare needs. My experience is that systems led by people with such clear biases as he has toward Medicare and Medicaid recipients are places that do a poor job of treating virtually all patients. The rest of the staff takes their cue from leadership’s open contempt for one group and determines that it is not only just as acceptable to be contemptuous of the subjects of their own varied biases, but it is also just fine to provide substandard treatment to those groups. Thus safety, quality and patient satisfaction end up being empty words in that system’s mission and vision statement.

  9. wendy says:

    He’s a CEO like I’m the King of England.

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