Overcoming Lower-Income Patients’ Concerns About Trust And Respect From Providers

From the blog post by Chris C. Duke and Christine Stanik on Health Affairs Blog:

For our Right Place, Right Time research initiative, launched in January 2016, we interviewed vulnerable patients, including low-income patients, the uninsured, family caregivers, and non-English speakers, to learn their most urgent concerns about the health care system and the information they need to make health decisions. We expected to hear that health care information was too confusing and price information was difficult to find—and we have—but the issue lower-income participants were most passionate about surprised us: they reported widespread distrust of the health care system and the feeling that they were seen as “less than” by health care professionals.

For many lower-income participants, trust and respect were their primary concern with the health care system, even more than the quality of the health care they received. Participants felt they were treated with less respect because of their income, insurance status, and race. This is consistent with past research finding that distrust in the health care system is high, and strongly associated with poor health.

In contrast, middle-income study participants did not report many negative experiences with providers, and those with negative interactions did not feel they were being targeted or discriminated against. It was as if lower- and middle-income patients had experienced two different health care systems.

Lower-income participants gave examples of a lack of trust and respect, including providers avoiding eye contact, speaking condescendingly, showing physical disgust when touching patients, brushing off patient concerns and symptoms, and ignoring adverse events that patients reported from prescribed treatments. Most of this criticism was directed at physicians of all types, and less directed at nurses and other provider types, who were perceived as having more in common with patients and as having no financial motivations in providing care. It was clear from participants’ descriptions that these events colored the entire patient experience and were highly influential in determining the care they later sought and received.

Read the full blog post.