The Patient Experience Divide: How Income Relates to Care Quality in the Primary Care Setting

Income is closely linked to morbidity and mortality in the United States, potentially due in part to differences in patient experience. However, existing studies on income and care experiences are outdated and have other important limitations.

Using data from a recent national sample of adults (N=5016), we conducted a mixed-methods investigation of the relationship between income and primary care experiences. Patient experience was measured using the CAHPS Clinician and Group survey (CG-CAHPS) and its associated Narrative Item Set (NIS). Closed-ended responses were used to create 4 composite measures, for example, access to care, while open-ended NIS responses were coded for positive and negative mentions of 7 aspects of care: access, coordination, communication, office staff, efficiency, thoroughness, and emotional rapport.

Contingent on mentioning an aspect of care in their narratives, low-income participants had lower unadjusted odds of making positive mentions of access, coordination, communication, office staff, efficiency, and emotional rapport (all P- values ≤0.02). Conversely, they had higher unadjusted odds of making negative mentions of coordination, communication, efficiency, and thoroughness (all P -values ≤0.006). Patterns were similar after controlling for education and other characteristics. Low-income participants also had scores on all CG-CAHPS composite measures that were 3-5 points lower than scores for higher-income participants (all P- values <0.001).

Low-income patients report fewer positive and more negative health care experiences than higher-income patients across multiple aspects of care. These deficits may contribute to their higher morbidity and mortality. Further research is needed to uncover underlying causes and inform policies and practices to ensure high-quality care for all patients.