From Inequality to Illness: Socio-Economic Status and Healthcare Disparities

Despite drastic changes and advancements implemented throughout global healthcare systems in recent years, healthcare disparities continue to exist within said systems, affecting the daily lives of millions of people worldwide. Although the causation for an individual’s exposure to healthcare disparities is multi-faceted, a primary constituent is an individual’s socioeconomic status. An analysis of the available literature revealsthat SES directly impacts the extent of healthcare disparities an individual will endure through the presence of financial barriers and stigma, which are often inextricably connected. In many cases, access to healthcare can be the determinant between life and death, which reaffirms the need to address healthcare disparities individuals of lower SES face today. 

Financial barriers to healthcare tend to manifest within populations that are of lower SES, inhibiting their ability to equitably access healthcare services, prompting healthcare disparities. The literature supports this notion, suggesting that low SES results in the inability to afford treatment and perpetuates a proportional relationship between low SES and ill health. Adam Wagstaff, former Research Manager of the World Bank Development Research Group, notes that “In developing countries, under otherwise constant conditions, higher income is associated with more frequent and intensive use of health services in both the private and public sectors…”  Carmen Chai and Beatrice Politi, writers for Global News also noted, “those who make more money or have high socioeconomic status are more likely to secure a doctor’s appointment compared to their lower-income counterparts.” It is evident that individuals of low SES are systematically disadvantaged in the healthcare system and as a result, are less likely to seek healthcare services, which inadvertently leads to poor health outcomes. Low SES makes it virtually impossible to access adequate healthcare due to a lack of financial resources; not only can such damages span across generations, but it can also result in a dangerous cycle of further impoverishment. Similarly, Mcmaughan et al., a group writing for the National Library of Medicine, comment on a similar notion, discussing how “…people are thus caught in a vicious circle: poverty breeds ill-health, ill-health maintains poverty.” The cycle of poverty is often exacerbated by the cost of maintaining one’s health, as people of lower SES who are living in poverty are often unable to access healthcare without the risk of substantial financial distress. For many people, receiving healthcare and being unable to work for a certain period of time is economically unfeasible, and the disregard of health issues only leads to an increased severity of the illness itself and a higher cost to treat it remedially. A prime example of this is preventative measures such as screenings. Mcmaughan et al., reveals that, “older adults living in higher socioeconomic brackets are more likely to access preventative care and screenings.” Despite the benefits of screenings, a medical strategy used to detect health problems when they are the most treatable, the data shows that people of lower SES are less likely to seek them, primarily for financial reasons. For example, it was found that only 41% of lower-income individuals had sustained a cholesterol test in the past year as opposed to 64% of higher income people. Moreover, 54% of lower income women between the ages of 50-64 hadn’t undergone a mammography, while 80% of higher-income people had.

It’s evident that individuals of lower SES are often treated differently than their higher SES counterparts, but how significant are these differences? Doctors often have a negative perception of their patients of lower SES, which directly impacts the course of treatment they choose to follow and the care that they provide to patients, often prompting inferior health outcomes. In comparison to their counterparts of higher SES, individuals with lower SES are less likely to be perceived as “intelligent, independent, responsible, or rational and doctors often believe that they are less likely to comply with medical advice and return for follow-up visits.” As a direct result, Arpey et al. notes that these patient perceptions may impact the physician’s clinical decisions, leading to delayed testing, generic medication prescriptions and avoidance of referrals for specialty care. All of these factors and perceptions can catalyze poor health outcomes very quickly, and treat individuals who are simply seeking healthcare unethically as they are not being treated adequately based solely on the basis of their SES. This notion is supported by Madeline Olson, writing for the University of New Hampshire, who elaborates that “health care stigma is also associated with insufficient and deferred care, infrequent check-ups, absence of needed tests, faster progression of illnesses, and overall lower quality of life.” As the evidence suggests, individuals of lower SES are often burdened by their financial situation which makes it difficult enough to access care, and once they do seek the care that they need, they aren’t treated fairly by medical practitioners which has direct consequences to their respective health outcomes. But, this phenomenon extends even further to publicly-financed healthcare, like Medicare. In terms of insurance specifically, it was found that physicians often chose not to provide care to individuals on publicly financed insurance as it results in lower reimbursement rates. Moreover, some doctors may choose not to accept Medicaid insurance and if they choose to do so, it was found that patients are often treated differently; wait times are longer, medications often aren’t prescribed quickly and more. Physicians often believe that the changes they make to a course of treatment based on their patient’s SES, will enhance patient outcomes by making the care more attainable, however, others mention that it is unethical to withhold potential information regarding health services from patients based solely on their SES. It is clear that even if direct financial barriers are weakened, healthcare practitioners often hold an internal bias against their patients based on their SES, which limits the care that an individual will receive, which in some cases may be the difference between life or death. 

Financial barriers to healthcare are often identified as the primary factors that influence someone’s access to healthcare, or lack thereof. To combat the debilitating impacts of low SES on the ability to equitably access healthcare, states around the world often seek to remove and weaken said financial barriers by providing insurance and reducing costs, to empower people of lower SES to access and frequent healthcare services more often and effectively, in an effort to prompt better health outcomes. However, governments often fail to address the presence of stigma in healthcare and refuse the notion that financial barriers to healthcare aren’t the only barrier impacting healthcare accessibility. The idea that financial barriers are the sole barrier to healthcare disregards the presence of stigma that often exists in provider and patient interactions, where a healthcare provider’s own perceptions of a patient may influence the quality and accessibility of the care they provide, often leading to poorer health outcomes. 

One’s socioeconomic status is inextricably linked to their experience in the healthcare system. It will likely dictate how accessible said healthcare is, and whether or not they will receive it at an adequate level. For people of lower SES, there are direct financial barriers that exist and stigma that often comes with their socioeconomic situation, which severely impacts their health outcomes. The ability to access healthcare plays an immense role in determining our livelihood and healthcare outcomes. An individual’s SES should not dictate the quality of care they receive and leave them feeling ignored by the healthcare system. To combat this issue, courses could be created to inform healthcare providers about their own potential biases and how to confront them, while governments can research the efficacy of publicly-financed insurance and where it is lacking in order to make it suitable for people of all SESs.