Low-Income Patients Want More Health Information, Greater Engagement with Providers

Washington, DC (Oct. 23, 2013) – As millions of low-income patients gain health coverage for the first time, a report released today by Blue Shield of California Foundation examines the opportunities and challenges in engaging this long-underserved population. "Building Better Health Care for Low-Income Californians" finds that clear, accessible information and open communication are key building blocks for forging strong patient-provider relationships, producing engaged patients and ultimately improving health outcomes.

"We must bring patients into the conversation if we want to transform health care in California and across the country," said Peter V. Long, PhD, president and CEO of Blue Shield of California Foundation. "The findings of this research make clear why communication is so important and provide a roadmap to better engage patients as our health system continues to evolve."

The report is based on an extensive statewide survey of low-income Californians, which found that just 28 percent feel they have all the easily comprehensible health information they need to make good decisions about their care. The rest, seven in 10, want more information from their providers if it is clear and accessible. Absent that, many patients turn to less trusted sources. Nearly 40 percent rely on media and the internet when they have health questions or concerns, the same as seek out physicians and other providers.

"The survey findings show that over-reliance on non-provider sources, which may present incomplete or incorrect details about a health condition, can be an obstacle to the goal of well-informed, engaged patients," Long said. "One of the best antidotes is a strong patient-provider relationship that encourages individuals to participate in their own health and wellbeing and connects them with the right information to do so. The health centers that act on this core finding will be that much more successful." 

The report recommends a range of strategies to improve communication and connection, identifying alternative care models and tools such as decision aids and internet-based patient portals as very effective approaches that should be increased. Results suggest that these approaches are particularly useful in helping patients feel that they have all the information they need and are well-informed about their health, among other important outcomes.

The report notes that many patients today are technologically savvy in ways that healthcare facilities and practices should utilize. If offered the opportunity, seven in 10 low-income Californians with email or cell phone texting capabilities say they would be interested in using them to communicate with their providers. 

Yet a significant digital divide persists between low- and higher-income Californians, and the health-related benefits of technology – such as interactive websites, smartphone apps, texts, and email reminders – are out of reach for many people. More than 40 percent of low-income Californians lack access to the internet, compared to only 13 percent of higher-income residents, and that lack of access rises sharply among non-citizens, non-English-speakers, Latinas, older patients and individuals in only fair or poor health.

Other survey findings include:


o   Low-income patients who report having a strong bond with their providers are far more likely to rate their quality of care positively, to feel that they have a voice in their care and to feel more confident in their decision-making ability.


o   Among low-income patients who say their provider encourages their involvement, nearly nine in 10 report feeling informed about their health.


o   Low-income patients enrolled in team-based care are much more likely than those without such a program to report feeling very informed about their health (57 percent vs. 38 percent).


o   Among low-income patients who have communicated with a provider via text or email, 87 percent find such communications to be useful.


Low-income Californians are "ready and eager" for new approaches, the report states, and the healthcare system has much room to improve how they and their providers communicate. "Such efforts hold forth the prospect of sharply improved patient-provider relationships, a crucial milestone on the road to successful patient engagement."



About the Survey

Blue Shield of California Foundation's survey of low-income Californians is based on phone interviews conducted from May 2-June 8, 2013 with a random statewide sample of 1,018 Californians ages 19 to 64 whose household incomes were less than 200 percent of the federal poverty level. Langer Research Associates of New York, NY managed, designed, and analyzed the survey and wrote the report. SSRS/Social Science Research Solutions of Media, PA conducted the sampling, data collection, and tabulation. The results have a margin of sampling error of plus or minus 3.5 points for the full sample.

About Blue Shield of California Foundation

Blue Shield of California Foundation's mission is to improve the lives of all Californians, particularly the underserved, by making health care accessible, effective, and affordable, and by ending domestic violence. Blue Shield of California Foundation is an independent Licensee of the Blue Shield Association. Visit: www.blueshieldcafoundation.org