Designing health care inclusively for people with low incomes: A policy-focused evidence brief

Healthcare systems often fail to meet the needs of low-income populations, reinforcing disparities in access, affordability, and quality of care. These inequities are not incidental but the result of design choices that prioritise efficiency and standardisation over inclusivity. Even in high-income countries with publicly funded healthcare systems, hidden costs, transport, parking, lost income, childcare, and the financial burden of following medical advice, can prevent people from accessing care. These financial barriers drive delays in treatment, missed appointments, and poorer health outcomes, entrenching health inequities.

This brief synthesises evidence from systematic and realist reviews, randomised controlled trials, qualitative studies, and programme evaluations, prioritising the most robust and policy-relevant findings of the structural barriers that low-income populations face in high-income healthcare systems. It identifies three challenges: (1) the cost of time and travel, (2) the lack of financial hardship awareness in healthcare settings, and (3) the affordability of care beyond direct medical costs. Solutions exist. Flexible appointment models, including evening and remote consultations, can mitigate financial strain. Community outreach services, such as mobile health units and pop-up clinics, improve engagement with preventive care. Social needs screening, widely used in North America, has been shown to improve health outcomes by identifying financial hardship and linking patients to support services. Food prescription programs offer an emerging model for addressing health and nutrition insecurity.

While healthcare alone cannot eliminate poverty, it can ensure that low-income populations are not left behind. Policymakers should embed equity into healthcare design, integrating financial support programs, expanding outreach initiatives and removing hidden costs that act as barriers to care.