Low Income Groups

The poor are defined as persons living in families whose household income falls below specific poverty thresholds. These thresholds vary by family size and composition and are updated annually by the U.S. Bureau of the Census. After falling for nearly a decade, the numbers of poor persons in America rose from 31.6 million in 2000 to 34.6 million in 2002, and the poverty rate increased from 11.3% to 12.1% over the same period.

Poverty varies by race and ethnicity. In 2002, 24% of Blacks, 22% of Hispanics, 10% of Asians, and 10% of Whites were poor.¹⁶ Persons with low incomes often experience worse health and are more likely to die prematurely.^17,18,19,20 In general, the poor have reduced access to high quality care. Income-related differences in quality of care that are independent of health insurance coverage have also been demonstrated.²¹

In previous chapters of this report, health care differences by income were described. In this section, disparities in quality of and access to health care for poorⁱⁱⁱ compared with high income^iv individuals are summarized. For each core report measure, poorer persons can have health care that is worse than, about the same as, or better than health care received by high income persons. Only relative differences of at least 10% that are statistically significant with p<0.05 are discussed in this report. Access measures focus on facilitators and barriers to health care and exclude health care utilization measures.

In addition, changes in differences related to income over time are examined in this section. Both absolute and relative differences are compared in current data and historical data. Core report measures for which both the absolute differences and the relative differences are becoming smaller over time are identified as improving disparities. Core report measures for which both the absolute differences and the relative differences are becoming larger over time are identified as worsening disparities. Uncommonly, absolute and relative differences do not agree on direction of change. In these cases, direction of change is unclear and results for these measures are not presented.

As in previous NHDRs, this section includes information on programs that may affect low income groups. Community health centers (CHCs) are vital sources of health care for many low income individuals. The care delivered in CHCs is also effective in reducing disparities: Black-White disparities in overall mortality and prenatal care and Hispanic-White disparities in tuberculosis case rates and prenatal care are smaller in States with better coverage of low income individuals by CHCs.²² Information on quality of and access to care provided by CHCs as well as on racial, ethnic, and socioeconomic differences in CHC care is also presented in this section.

Figure 4.15. Poor compared with high income individuals on measures of quality and access

[D] Select for Full Text Description.

Better: = Poor receive better quality of care or have better access to care than high income individuals.

Same: = Poor and high income individuals receive about the same quality of care or access to care.

Worse: = Poor receive poorer quality of care or have worse access to care than high income individuals.

CRM: = core report measures.

Note: Data presented are the most recent available.

• Less than half of the core report measures supported estimates of quality for the poor.
• For 11 of the 13 core report measures of quality with income data, the poor had significantly poorer quality of care than high income individuals (Figure 4.15). Poor-high income differences ranged from poor parents being over three times more likely than high income parents to report communication problems with their child's providers to poor individuals being 10% less likely to lack needed substance abuse treatment. The median difference was 40% (the poor 40% more likely than high income individuals to receive poorer quality care).
• For all 8 core report measures of access, the poor had significantly worse access to care than high income individuals. Poor-high income differences ranged from the poor under age 65 being over six times as likely as high income individuals to lack health insurance to the poor being 67% more likely to lack a primary care provider. The median relative rate was 2.5 (the poor are 2.5 times more likely than high income individuals to have worse access).

Figure 4.16. Change in poor-high income disparities over time

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Improving: = Poor-high income difference becoming smaller.

Worsening: = Poor-high income difference becoming larger.

CRM: = core report measures.

Note: The most recent available and oldest years of data available are compared.

• Less than half of the core report measures supported estimates of changing disparities in quality for the poor.
• Of core report measures of quality that could be tracked over time for poor and high income individuals, poor-high income differences became smaller for 5 measures but larger for 5 measures (Figure 4.16). For 1 measure—smokers with advice to quit—a new significant difference was seen.
• Of core report measures of facilitators and barriers to health care that could be tracked over time for poor and high income individuals, poor-high income differences became smaller for 1 measure but larger for 4 measures. While more access measures showed decline than showed improvement in income-related disparities, the largest magnitude change observed was a narrowing of the poor-high income gap in health insurance.

ⁱⁱⁱ Household income less than Federal poverty thresholds.

^iv Household income 400% of Federal poverty thresholds and higher.

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