How Income Inequality Affects Health Equity, Patient Experiences

January 14, 2020 - Nearly half of lower- and middle-income adults struggle to pay their dental and healthcare bills, underscoring latent issues with health equity in this country, according to a report from the Robert Wood Johnson Foundation, NPR, and the Harvard T.H. Chan School of Public Health.

This comes in stark contrast with the highest income bracket that earns more than $500,000 and makes up 1 percent of the US population. Only about one in ten of these top-earners say they have trouble paying for their medical bills, according to the survey of 1,885 individuals.

Fifty-seven percent of low-income and 48 percent of middle-income adults say they have trouble paying for their medical bills.

These healthcare disparities, which the survey showed also extend to food and housing access, mark a need for health policy change, RWJF President and CEO Rich Besser said in a press release.

“It is simply unacceptable in a country as wealthy as ours that so many people lack sufficient income to pay for health care, housing or even food,” Besser asserted.  “We need to address income inequality if we truly want everyone to have a fair and just opportunity to live the healthiest life possible.”

Seven in ten survey respondents across all income levels agreed having a higher income makes it easier to access and pay for healthcare. Nearly half of the top 1 percent and over half of lower-income adults (those making less than $35,000 annually) said it is unfair that higher income earners can obtain better medical care.

And nearly everyone agrees the government needs to intervene to address these disparities. Over half of all respondents regardless of income said it should be a governmental priority to address income inequality and make insurance accessible for everyone, although more low-income respondents (71 percent) support this than the wealthiest respondents do (53 percent).

Income is also impacting the way patients perceive healthcare and their experiences with public health and their own wellness. Specifically, individuals with different incomes harbor different health concerns.

Although nearly all respondents cited issues with drug addiction and healthcare access, concerns diverged from there. Wealthier respondents said obesity was their leading healthcare concern, while middle- and low-income respondents were slightly more likely to cite cancer as a health concern.

Income also has an impact on other lifestyle needs that can affect health, like housing and food security. Housing and food are key social determinants of health, and when individuals do not have access to quality food or housing, their wellness may deteriorate.

Thirty-five percent of low-income adults and 25 percent of middle-income adults have trouble securing housing, the survey revealed. This is compared to just 4 percent of the top income earners.

Thirty percent of low-income adults and 13 percent of middle-income adults also said they have “serious problems” accessing food, compared to less than 1 percent of high-income earners who said the same.

This finding says nothing of the quality of food individuals are able to access. Accessing food, while important, is not the whole of the puzzle. Individuals also need access to healthy food in order to achieve wellness.

As noted above, these findings suggest a need for healthcare policies that promote health equity and better access to care for all patients. Programs that drive better health insurance coverage and address the social determinants of health will be central to this effort.

“These findings reinforce national concerns about the impact of large-scale income inequality in the U.S. today,” said Robert J. Blendon, co-director of the survey and the Richard L. Menschel Professor of Health Policy and Political Analysis at Harvard T.H. Chan School of Public Health. “This report lays out in vivid detail the impact the income gap has on people’s day-to-day lives.”