Low Socioeconomic Status Negatively Impacted Healthcare Delivery

Medicare beneficiaries in low socioeconomic status (SES) areas had higher rates of avoidable hospital admissions and emergency department visits but lower instances of physician and care management visits, suggesting that poor healthcare delivery systems are exacerbating health inequities, a Socioeconomic Status and Health Care Delivery System Performance report from 3M Health Information Systems found.

Individuals with low socioeconomic status tend to have less comprehensive health insurance coverage. Additionally, socioeconomic status can significantly impact health outcomes, patient satisfaction, and physician perception of the care and treatment a patient needs. 

“We conducted this study to help identify differences in healthcare delivery system performance in low SES areas. When we understand exactly what the differences are, then healthcare leaders and policymakers can begin to develop plans that address those performance differences,” Rich Averill, report co-author, a research consultant, and former vice president of clinical and economic research for 3M HIS, said in a press release.

“Leveraging the power of data and using clinically credible research methodologies can provide actionable information and identify performance differences that are real opportunities for improvement.”

The Socioeconomic Status and Health Care Delivery System Performance report used 2018 Medicare fee-for-service claims data from the Medicare Standard Analytic Files (Limited Data Set). The data represents more than 25 million Medicare beneficiaries.

Researchers determined the impact of SES on healthcare delivery system performance by evaluating performance measures in four categories, including population, post-acute care, quality, and service volume.

The report found that low SES counties had fewer beneficiaries, fewer hospitals, more dual eligible beneficiaries, and more minority beneficiaries.

Beneficiaries with low SES experienced higher-than-expected rates of potentially preventable events, including hospital admissions and readmissions, emergency department visits, and complications. For example, the number of potentially avoidable hospital admissions was 7.5 percent higher than expected for low SES beneficiaries, based on the risk-adjusted national rate.

These beneficiaries also had higher surgical mortality rates than Medicare beneficiaries in counties with high SES.

According to the report, a properly functioning healthcare delivery system should minimize the rates of potentially preventable events and surgical mortality.

Beneficiaries with high SES had lower-than-expected rates for the same measures, indicating that the delivery systems in their counties were more efficient. For example, the number of avoidable hospital admissions for this population was 4.5 percent lower than the expected rate.

Beneficiaries in low SES counties had lower rates of service volume measures compared to beneficiaries in high SES counties. Beneficiaries in low SES counties were less likely to be admitted to the hospital from the emergency department and less likely to be admitted to a skilled nursing or rehabilitation facility following a hospital discharge. In addition, these individuals had fewer physician or care management visits.

The under- or over-use of these services may be attributed to implicit bias, health insurance limitations, and the uneven distribution of healthcare services, the study suggested.

The report also ranked hospital performance across geographic areas and categorized the health systems using the equity component of the Lown Institute Hospitals Index. The equity component measures hospital social responsibility based on inclusivity, pay equity, and community benefit.

Around 40 percent of hospitals with a high equity score from the Lown Index were in the bottom 25th percentile, with the greatest percent of patients from counties with a low SES. Preventable admissions and readmissions and surgical mortality were higher-than-expected among these hospitals.

The study results suggest that healthcare delivery systems in low SES areas are not functioning correctly, creating health equity concerns.

Incorporating SES factors into risk adjustment and increasing risk-adjusted payment levels for low SES beneficiaries may help provide better financial investment in these areas, researchers said. With this method, areas of poor performance would have to be highlighted for hospitals to improve performance measures.

Incorporating an SES geographic payment adjustment factor into the payment system may be another solution. Under this method, the additional funding should be contingent on improvement based on performance measures, such as preventable events, the researchers said.