This report summarizes research commissioned by the Blue Shield of California Foundation on the experiences and attitudes of low-income patients in California.

Among the report’s findings:

+ Only 49 percent of low-income Californians rate the quality of their care positively – vs. 69 percent of their higher-income counterparts.
+ Compared with higher-income Californians, those with low incomes are 19 percentage points less apt to report continuity in their care (i.e., that they usually see the same provider on each visit), 53 vs. 72 percent, and 14 points less apt to say someone at their care facility knows them pretty well (i.e., connectedness), 38 vs. 52 percent. As shown in a 2012 Foundation study, continuity and connectedness are key predictors of patient empowerment and efficacy.
+ Information also is central to engaged, efficacious patients, and low- income Californians are 12 points less apt than higher-income residents to feel very informed about their health, 43 percent vs. 55 percent.
+ Low-income residents score 9 to 13 points lower than higher-income Californians on a range of questions evaluating their relationship with their providers, such as feeling they have a great deal of say in decisions about their care, being very comfortable asking questions, feeling welcome to share outside information with providers and being asked by providers if they have questions or concerns.
+ Comparing only low- and higher-income Californians who HAVE internet access, low-income patients are still 18 points less likely to say they receive e-mails from healthcare providers or staff (22 vs. 40 percent) and 13 points less apt to say they can e-mail questions to those care professionals (32 vs. 45 percent). Low-income Californians overall also are less apt to say their providers offer a “patient portal” website, 29 vs. 40 percent. The digital divide thus is compounded by the fact that even when low-income Californians DO have internet access, their health care providers are less likely to use these communication channels.

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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