A Closer Look into Health Care Disparity: Social Risk Survey 2023

In July, Engagys published a Social Risk and SDoH Consumer Survey Findings eBook, which highlighted consumers’ ability to access care, behavioral health and isolation challenges, transportation barriers, and discrimination. In this post we dive deeper to understand the pitfalls health plans are facing and to give recommendations and share opportunities for achieving true health equity amongst consumers.

Consumers are Delaying Care
 

Various groups are delaying care. Blacks are 30% more likely to do so than whites. Those who reported a disability are 24% more likely to delay care than the nondisabled. Respondents whose income falls between $50k-75k are the most likely income group to report delaying care. And those whose income falls under $25k delay care at a rate nearly equal to those at or above $125k. The findings between income groups were a surprise. One explanation may be that the middle-income groups struggle the most with the expense of deductibles, copays, and coinsurance while the lower-income group may have low-cost Medicaid benefits and other sources of financial support.

Healthcare Experiences Vary by Population
 

While the vulnerable groups of Blacks and the disabled are prone to delaying care, they do report that they experience high-quality care when they receive it. Blacks are the most likely to report being able to get all their medical/health questions answered: 21% more likely than Hispanics and 12% more likely than whites. However, the same is not true for low-income respondents. Those whose incomes fall under $25k are 9% more likely to struggle getting their questions answered than those with incomes between $50k-75k.

When it comes to getting the help they need across different providers and services, Blacks and the disabled also fared better than other groups. Blacks were most likely to report getting the help they needed: 21% more likely than Hispanics and 7% more likely than whites. Low-income individuals continue to struggle - those with incomes under $25K being 17% less likely to get the help they need than those whose incomes fall between $50k-75k.
 

Although the vulnerable groups of Blacks and the disabled report higher delays of care than their counterparts, perhaps when they do receive care, they make the most of it to get their questions answered and their issues addressed.
 

Social Isolation is Still a Major Factor
 

Race, disability, and income play a role in feelings of isolation as well. Hispanics are 22% more likely than whites to report feelings of loneliness while Blacks are 22% less likely than whites to report the same. The disabled are 36% more likely to report feeling lonely than the nondisabled. Respondents with incomes under $50k are 45% more likely to report feeling lonely than those with incomes at or above $125k.

Lack of Transportation Remains a Challenge
 

The barriers associated with transportation highlight the way interconnected issues like class, race, and disability compound one another. Blacks are 230% more likely than whites to report that transportation is a barrier, and the disabled are also 230% more likely than the nondisabled to report the same. Those with incomes under $25k are 24% more likely to report issues than those whose incomes fall between $50k-75k and 250% more likely than those with incomes at or above $125k.

Transportation barriers could also be attributed to the lack of a social support system, so the fact that feelings of isolation follow transportation challenges is no surprise. If you struggle to get out and about, it is hard to proactively maintain relationships. Others have found that Blacks are less likely to live alone or have limited contact with religious congregations than whites. These connections are protective of health and wellbeing.
 

Discrimination in Health Care is Not Just About Race
 

Discrimination is not evenly felt amongst health consumers and extends beyond race and ethnicity. Hispanics are 300% more likely and Blacks are 200% more likely to report feeling discriminated against than whites. Disabled respondents were 300% more likely to report discrimination than nondisabled respondents.

Overall Confidence in Care Depends on Ethnicity, Age and More
 

One of the fascinating patterns to emerge from the survey is that populations that struggle to get to the doctor’s office because of barriers like transportation and income, are more likely to report that they get the answers they need while in the office and the help that they ask for. It's possible that this reflects a sort of selection bias - one that we frequently observe in communications. The harder it is for someone to get past the screening steps the more likely they are to complete the task. However, when it comes to confidence in maintaining one's care, the typical patterns associated with inequity return. Again, it could be that people contemplating how to stay healthy know that getting the care they need is not as easy as it is for others. A similar sort of pattern exists with age. Older respondents consistently report having an easier time getting care. Perhaps they’ve learned how the system works.

Hispanics are 25% less likely to report feeling confident in their ability to take care of themselves than whites. The disabled are 18% less likely to report confidence than the nondisabled. When it comes to income, individuals with income under $50k are 15% less likely to report confidence than those whose incomes are at or above $125k.
 

Implications for Health Plans
 

While disadvantaged groups report the ability to get what they need once in the office or clinic, they are more likely to put off care and struggle to get to the office in the first place. These groups, apart from Blacks, are also more likely to face feelings of loneliness and all disadvantaged groups report discrimination, which may explain their hesitation to seek care in the first place. Therefore, nonvulnerable groups feel better about their health prospects.
 

Given these findings, what can the health plan industry, particularly health plans with Medicare and dually eligible members do to close these health equity gaps? Discover more in our Social Risk and SDoH Consumer Survey Findings 2023 eBook.

Special thanks to co-author Bradyn Radford