Primary Care Research

Patient and practice socioeconomic status are independently associated with care among privately insured patients

It has been well documented that patients of low socioeconomic status (SES) receive less optimal health care services than higher SES patients. These effects are less well documented in privately insured patients. However, a new study shows these effects in privately insured patients, and also that physicians in low SES practices (serving predominantly low-SES patients) provide fewer screening services but more diagnostic testing than those in higher SES practices.

These effects are not confined to the poorest patients of these practices but span the entire socioeconomic spectrum of patients. Use of patient zip codes is a relatively easy way to identify patients and practices at risk for these effects, suggests Peter Franks, M.D., formerly of Highland Hospital of Rochester, and currently with the University of California, Davis.

With support from the Agency for Healthcare Research and Quality (HS09963), Dr. Franks and his colleagues analyzed the claims data of 568 primary care physicians and their 437,743 adult managed care organization (MCO) privately insured patients in the Rochester, NY, area. They examined use of screening exams, physician visits, specialist referrals, hospitalizations, and office visit and testing costs by patient zip-code-based SES and physician practice SES (mean SES of patients in the practice).

Lower SES patients had lower compliance with Pap smears, mammograms, and diabetic eye exams, and they were less likely to have a referral or make any office visit. However, they were more likely to be hospitalized, and they had higher diagnostic testing expenditures. Lower physician practice SES was associated with lower compliance with Pap smears, mammograms, and glycohemoglobin tests (blood test for diabetes) and lower office visit expenditures but higher diagnostic testing and total expenditures. Patient SES effects were stronger for mammography, whereas physician practice SES effects were stronger for diagnostic testing costs.

Details are in "Effects of patient and physician practice socioeconomic status on the health care of privately insured managed care patients," by Dr. Franks, Kevin Fiscella, M.D., M.P.H., Laurel Beckett, Ph.D., and others, in Medical Care 41(7), pp. 842-852, 2003.

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