“This may yet be the greatest test of our healthcare system – whether we can effectively bring patients into the conversation, instead of leaving the debate to politics, payers, and providers. We hope this report’s findings bring us closer to this goal, and help illuminate the way forward.”
– Peter V. Long, Ph.D., President and CEO, Blue Shield of California Foundation

This report summarizes research commissioned by the Blue Shield of California Foundation on the experiences and attitudes of low-income patients in California. Understanding patients’ perspectives is a critical element of health care redesign. The “triple aim” of enhancing care experiences, improving health outcomes, and reducing costs relies on nurturing patients’ engagement in their care and their openness to new care approaches. Those in turn require understanding how patients gather and use information and communicate with their providers – the foundation of successful health care experiences.

Among the major findings:

+ Patients who have a stronger bond with their providers are a vast 43 percentage points more likely to feel they have a voice in their care, 35 points more likely than others to rate their quality of care positively, and 26 points more strongly confident in their decision-making ability.

+ 55 percent of low-income Californians say they’d like more information for decision-making purposes – and if that information is clear and easily accessible, interest jumps to 71 percent.

+ Patients enrolled in team-based care are 19 points more likely than others to report feeling very informed about their health and 15 points less likely to feel they need more information in order to make good health care decisions.

+ Although relatively few low-income patients currently can communicate with their providers by text or e-mail (16 and 23 percent, respectively),87 percent of those who do so find it useful – most of them, “very” useful. And among those who don’t have these communication options, sizable majorities are interested.

+ The well-documented digital divide continues: 42 percent of low-income Californians lack access to the internet (compared with just 13 percent of higher-income residents). The divide narrows for cell-phone use, but still one in five lacks a text-messaging capable cell phone.

The analysis was conducted by Langer Research Associates, based on interviews conducted by SSRS/Social Science Research Solutions in English and Spanish on landline and cellular telephones in May-June 2013 with a representative, random sample of 1,018 Californians ages 19 to 64 with household incomes less than 200 percent of the federal poverty level, and 498 Californians with household incomes at 200 percent of the federal poverty level and higher. The margin of sampling error is plus or minus 3.5 percentage points for the low-income sample and plus or minus 5 percentage points for the higher income sample.

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