Association of Income Disparities with Patient-Reported Healthcare Experience

Victor Okunrintemi, Rohan Khera, Erica S. Spatz, Joseph A. Salami, Javier Valero-Elizondo, Haider J. Warraich, Salim S. Virani, Ron Blankstein, Michael J. Blaha, Timothy M. Pawlik, Kumar Dharmarajan, Harlan M. Krumholz, Khurram Nasir

Research output: Contribution to journalArticlepeer-review

45 Citations (Scopus)


Background: Disparities in health outcome exist among patients according to socioeconomic status. However, little is known regarding the differences in healthcare experiences across the various levels of income of patients. In a nationally representative US adult population, we evaluate the differences in healthcare experiences based on patient level of income. Objectives: To evaluate the differences in patient healthcare experiences based on level of income. Patients and Methods: We identified 68,447 individuals (mean age, 48 ± 18 years; 55% female) representing 176.8 million US adults, who had an established healthcare provider in the 2010–2013 Medical Expenditure Panel Survey cohort. This retrospective study examined the differences in all five patient-reported healthcare experience measures (access to care, provider responsiveness, patient-provider communication, shared decision-making, and patient satisfaction) under the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. We examined the relationship between patient income and their healthcare experience. Results: Overall, 32% of the study participants were high-income earners while 23% had very-low income. Lower income was consistently associated with poor patient report on healthcare experience. Compared with those with high income, very-low-income-earning participants had 1.63 times greater odds (OR 1.63, 95% CI 1.45–1.82) of experiencing difficulty accessing care, had 1.34 times higher odds (OR 1.34, 95% CI 1.25–1.45) of experiencing poor communication, had higher odds (OR 1.68, 95% CI 1.46–1.92) of experiencing delays in healthcare delivery, and were more likely to report poor provider satisfaction (OR 1.48, 95% CI 1.37–1.61). Conclusion: Lower income-earning patients have poorer healthcare experience in all aspects of access and quality of care. Targeted policies focusing on improving communication, engagement, and satisfaction are needed to enhance patient healthcare experience for this vulnerable population.

Original languageEnglish
Pages (from-to)884-892
Number of pages9
JournalJournal of General Internal Medicine
Issue number6
Publication statusPublished - 15 Jun 2019
Externally publishedYes


  • patient-reported experience
  • quality of care
  • socioeconomic disparities


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