The number of days people stay home ill is influenced by neighborhood poverty and whether they receive subsidized health care, such as Medicaid, says a Purdue University urban sociologist.
"As state policy-makers decide whether to cut or invest in their state health insurance programs, such as Medicaid, they need to better understand factors, both systemic and individual, that influence whether and how people seek treatment for illnesses such as diabetes and high blood pressure," said Sandra Barnes, assistant professor of sociology.
"Limited health-care options mean that many people in poor urban communities are less likely to seek preventive care that could help them better manage their illnesses. In too many instances, this means that residents are forced to turn to emergency care in the form of expensive hospital emergency rooms."
Barnes found that difficulty in obtaining adequate, affordable, accessible health care undermines the health of many residents in poor urban neighborhoods. The problem is particularly acute for urbanites who are women and for racial/ethnic minorities.
"Policy should be shaped to provide more health-care assistance for the working poor – people who are employed but do not earn enough money to purchase health care or make too much to qualify for Medicaid," Barnes said. "If not, we will see higher mortality rates and a decrease in people's quality of life."
Additional health-care facilities also should be a priority for impoverished urban areas as should improving existing services and providing incentives for physicians to establish practices there, she wrote in Research in the Sociology of Health Care: Chronic Care, Health Care Systems, and Services Integration. The journal edition was published in March.
"I wanted to know whether poor people's health-care decisions are affected by neighborhood poverty and if they differ among races," Barnes said.
This study is different than others because it considers the availability, accessibility and affordability of basic health care for residents in poor urban areas, including those who are regularly employed but whose income is below the nation's poverty level, Barnes said.
"Interestingly, residents in less poor neighborhoods were more likely to stay home ill from work than those who lived in more impoverished neighborhoods," Barnes said. "And people who identified their health as fair or poor were less likely to seek regular care or spend days home from work or in the hospital. These results illustrate that, because of economic hardship, some poor people cannot afford to become sick."
Barnes attributes this largely to a lack of affordable services and health-care coverage, especially for some minority groups. Barnes found that African-Americans in the study relied on hospital outpatient care at twice the rate – more than 33 percent – of whites, Puerto Ricans and Mexican-Americans. A greater percentage of working African-Americans and Mexican-Americans, almost 30 percent and 40 percent, respectively, do not have health insurance coverage, Barnes said. African-Americans and Mexican-Americans living in an urban area were the least likely to remain home or spend time in the hospital when ill, while whites and Puerto Ricans were more likely to stay home.
"Those who seek care at urban clinics or don't seek health care at all were less likely to stay home from work," she said. "People who don't receive treatment for their illnesses may face more expensive complications later in life.
"Yes, individuals decide whether to seek preventive health care, but policy-makers need to realize there are greater external forces, such as subsidized health care, that are influencing those decisions."
Barnes' findings are based on data of 2,490 African-American, Mexican-American, Puerto Rican and white Chicago residents from the University of Chicago's Urban Poverty and Family Life Survey. For those surveyed, the average annual household income was less than $15,000, and more than three-fourths of the respondents were employed. Barnes analyzed relationships between health care accessibility and the number of days a person stayed home ill or was hospitalized in 1986.
"Poverty, which has continued to increase during the past 20 years, remains central to urban living," said Barnes, whose next book provides an in-depth look at economic costs incurred and decisions faced by the working poor in Gary, Ind. The book will be released this summer.
"It is more difficult for people to focus on their own their illnesses when they are worried about feeding and clothing their children."