Patient Care Access News

Low-Income Patients Cite Financial, Cultural Barriers to Care

Fifty percent of low-income patients are dissatisfied with their providers' price transparency, citing it as a primary barrier to care.

By Sara Heath

Low-income and otherwise vulnerable patients are facing barriers to accessing their healthcare, citing lack of cost transparency and insufficient language assistance as primary issues, according to a recent survey conducted by Oliver Wyman and the Altarum Institute, funded by the Robert Wood Johnson Foundation.


The survey of nearly 4,000 respondents focused on low-income patients, Medicaid beneficiaries, the uninsured, or Spanish speakers as a way to identify patients who regularly face challenges in accessing care that meets their physical, personal, and financial needs.

“Many consumers, especially the most vulnerable, face significant barriers in finding the information they want and need,” said Andrea Ducas, program officer at the Robert Wood Johnson Foundation. “We must address serious gaps in access to information in order to build an inclusive health care system for all.”

According to survey findings, healthcare organizations need to focus on their price transparency policies as well as their interpersonal relationships with low-income and vulnerable patients in order to better serve a growing and diverse patient population.

Improving price transparency information

READ MORE: Using At-Home Treatment to Drive Patient Satisfaction, Access

Overall, 50 percent of patients reported dissatisfaction with their providers’ price transparency, with low-income patients more likely to report this than middle-income patients.

Improvements in price transparency are even more urgent for uninsured patients, with 70 percent reporting a need for better cost of care information. These patients are also less likely to consult outside resources for cost information, with most conferring with friends and family on the matter.

Access to cost information is critical when making decisions about where and when to seek treatment. Thirty-nine percent of patients consider whether a primary care provider accepts their health insurance before visits, for example, and 36 percent said they consider cost of care before going to an urgent care or retail clinic.

Low-income patients are more likely to follow this trend than middle-income patients, according to the survey, further emphasizing the role that price transparency plays in healthcare access.

As patients continue to shop around for the most cost-effective treatment, healthcare organizations need to make their offerings widely available to patients. In doing so, organizations can not only maintain patient retention rates, but can improve satisfaction.

READ MORE: Understanding Mental Barriers to Patient Medication Adherence

“Consumers consistently rank clearer patient cost information as their top priority for improving health care overall,” the report says. “This is especially true for lower-income and uninsured consumers. Providing greater patient cost transparency should be a top priority for all health care stakeholders, including payers and providers.”

To that end, the report authors suggest healthcare organizations present cost information using multiple types of media. Cost and insurance information should be posted on organization websites as well as on printout materials available in the office.

Driving better patient-provider relationships

According to the survey, nearly half of Spanish-speaking patients consider language barriers their biggest healthcare challenges. Language barriers not only keep these patients from having seamless conversations with their doctors, but bar them from interacting with the healthcare system as a whole.

“In addition to difficulty understanding costs, just under half of Spanish-speaking survey respondents also say that language issues present a barrier when communicating with doctors or reading printed materials, such as forms,” the report states.

READ MORE: Patients Prioritize Costs, Convenience when Selecting Docs

“During our interviews, several Spanish speakers noted that even when translators or Spanish language versions of forms are available, patients may be reluctant to ask for or use these resources.”

Because Spanish-speaking patients do not always access these resources, they largely rely on their friends and family to translate and offer health guidance. Spanish speakers were twice as likely to trust their friends’ and families’ viewpoints (40 percent) than information from English speakers (22 percent).

Perception of respect also presented barriers to patient-provider interactions, with 40 percent of low-income patients walking away from appointments feeling disrespected, adversely impacting their care.

Patients who feel disrespected are three times less likely to trust their providers and two times less likely to adhere to treatments than those who do feel respected.

This poses a considerable problem, the report points out, because a many of those with negative perceptions of provider interactions are in poorer health.

Facilitating positive patient-provider interactions and guaranteeing a respectful visit need to be high priorities for healthcare organizations.

“Treat consumers with respect, regardless of coverage type or demographics,” the report advises. “Maintain and promote a culturally sensitive atmosphere across all organizations. Consider developing and promoting measures that help denote whether patients feel respected by particular providers. Hold providers accountable for being respectful to patients.”

Making treatment costs readily available can assist patients in selecting their providers and in the financial planning necessary to beginning treatment. And as patients increase their interactions with their providers, it will be important that they offer information in a patient’s preferred language and ensure each interaction is characterized by dignity and respect.

Ultimately, these strategies can enable healthcare organizations to offer patients, regardless of background, the opportunity to receive quality medical care.

“We have placed an increasing burden on consumers to make smart decisions about their healthcare or risk their own wellbeing. Despite this, we have not always equipped consumers with the information they need to manage their health affordably,” concluded Chris Duke, PhD, research director of the consumer study and director of Altarum Institute’s Center for Consumer Choice in Health Care.

“Today’s healthcare organizations need a multi-pronged strategy to ensure they are providing all consumers with the right information, in the right place, at the right time,” added study lead Helen Leis, Oliver Wyman partner.

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