Are Poor People Less Healthy Than Wealthy People

Inpatient Admissions
If poor people were as healthy as the rest of America, we actually would not see any decline in inpatient admission because the rest of America is really not very healthy. As several studies have recently noted, an alarming trend is occurring in American health care: wealthier Americans are now receiving more care than poorer Americans. As Almberg (2016) notes, “in 2012, the wealthiest fifth of Americans got 43 percent more health care ($1,743 more per person) than the poorest fifth of Americans, and 23 percent more care ($1,082 per person) than middle-income people.” With the rising cost of health care and the rise in premiums and deductibles—along with the long waits just to receive care in many health care facilities (Nicks, 2012), poor people are foregoing inpatient care while wealthier individuals are filling up the spot.
The big surprise is that wealthier people are also becoming less healthy in recent years. They are consuming more fast food (Grabmeier, 2017), their diet is poor, their reliance upon pharmaceuticals for treatment is increasing, and they are not exercising or receiving the type of preventive care needed to keep them from being in a position where they need more and more treatments to address health issues (Goldhill, 2009).
The assumption that poor people are less healthy than middle and upper class people in America is based on older studies. The newer and more recent trends in health show that middle and upper class people are actually going to receive care more than in past decades. Equating poverty with poor health or poverty with inpatient visits is also misleading because two of the big issues that impact inpatient rates are 1) access to primary care (the expansion of which is a Healthy People 2020 objective) and 2) a lack of preventive care. ER admission is going as a result of both of these issues, and while many people who rely on Medicare and Medicaid will use the ER to obtain inpatient services (Nicks, 2012), the reality is that inpatient services are not primarily being sought by poor people. The rest of America is splurging for health care services as well, which indicates that health issues are problematic for all people regardless of class or income level.
Therefore, if poor people were as healthy as the rest of America, it is more likely that inpatient admission rates would actually increase, as the rest of Americans are not so healthy that they are abstaining from inpatient services. What’s more is that hospitals are less willing to take on poor people as inpatients as it is, since the funding for this type of patient is not guaranteed. Cutler and Morton (2013) show that “the Affordable Care Act (ACA) reduced the growth of Medicare hospital reimbursement by about 1.5 percentage points annually, the latest in a series of payment reductions stretching backmany years. Cash-strapped state governments have reduced fees to inpatient institutions. The presumed revenue enhancement from expanded insurance coverage may not occur if states choose not to adopt the ACA Medicaid offer; 26 states have stayed out initially. These financial challenges will make it even more difficult for weaker hospitals to survive on their own” (p. 1967). Thus, to imagine that it is the person’s health alone that factors into whether poor people are gaining inpatient care is to ignore a number of other factors. Whether the person is covered will play a factor, and whether the care provider is in a weaker hospital where financial challenges such as those describe above are particularly problematic.
Likewise, as Kripalani, Theobald, Anctil and Vasilevskis (2013) show, inpatient admissions are often readmissions—i.e., outpatients who have already received care but have fallen back into needing more care after a brief stay at home. In other words, they have either relapsed or have not received proper follow-up care and therefore need to be readmitted. The causes of these readmissions have nothing to do with poverty or income levels but rather with administrative policies on the part of the health care facilities and on whether or not clinics can offer the kind of preventive care, follow-up care, or telemedicine care that patients require after receiving inpatient services. How health care providers respond to outpatient needs plays a significant part in admission rates, especially as re-admissions are a serious issue for many providers: once an inpatient has been treated and released, a number of steps and procedures must be taken to ensure that the patient is not immediately readmitted in subsequent days. These steps are not always taken and they have more to do with the health care providers’ efficiency than with the income level of the patient.
In conclusion, inpatient admission rates are impacted by a number of factors, not only by the number of poor people who are admitted for health care services. Also, the assumption that poor people are generally less healthy than middle class or upper class people is not supported by recent evidence which shows that wealthier people are receiving health care services more than poor people in recent years. Part of the reason for this is that with so much treatment being covered by insurance, health care providers are willing to provide treatment options for patients who are covered, while patients who are not covered are financially risky, especially for clinics that are weak in terms of the funding they receive from the government. Additionally, other factors, such as the extent to which preventive care is exercised and the extent to which follow-up care for outpatients is administered, will impact admission rates.
References
Almberg, M. (2016). Wealthier Americans now receive much more health care than
middle class or poor, reversing a 50-year trend: Harvard study. Retrieved from http://www.pnhp.org/news/2016/july/wealthier-americans-now-receive-much-more-health-care-than-middle-class-or-poor-rever
Cutler, D., Morton, F. (2013). Hospitals, market share, and consolidation. JAMA,
310(18), 1964-1970.
Goldhill, D. (2009). How American health care killed my father. Retrieved from
https://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/
Grabmeier, J. (2017). For richer or poorer, we all eat fast food. Retrieved from
https://news.osu.edu/news/2017/05/04/eat-fast-food/
Kripalani, S., Theobald, C., Anctil, B., Vasilevskis, E. (2013). Reducing hospital
readmission: Current strategies and future directions. Annual Review of Medicine, 65, 471-485.
Nicks, P. (2012). Waiting for health care. Retrieved from
http://www.nytimes.com/2012/05/21/opinion/for-the-uninsured-the-wait-for-health-care.html