Patients as Consumers of Health Care: a Case Study of the Patient Experience in a Sample of the San Mateo County Low-income Population Receiving Care in an Emergency Department

Patients’ perceptions of care have become increasingly significant in the evaluation of healthcare in the last decade in the United States. Hospitals now receive funding according to patients’ ratings of their hospital experience on the first national publicly reported survey, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). (Zusman, 2012) The HCAHPS does not ask for the patient income range, indicating that currently there is no way to look at the trends of patient experience for the low income population. Studies have shown that the low-income patient subgroup experiences unique challenges in the context of health care and that the emergency department (ED) acts as a social welfare institution for them. (Gordon) This study was designed to elucidate concerns that patients with low socio-economic statuses have about their health care experiences in the ED. Particularly, the goal of this research was to examine the cultural experience of the Stanford ED visit amongst low-income patients from San Mateo County.
The Stanford ED, a Level 1 pediatric and adult trauma center, is unique in that it treats a subpopulation with extreme wealth as well as one of extreme poverty. This study used an ethnographic approach that incorporated interviews and participant observation. Thirty responses that characterize the range of experiences in the ED were chosen for analysis.
In investigating themes that specifically relate to the perception of care of the low-income population in the ED, this study found that these patients placed greatest emphasis on waiting time, pain control, and communication with and attentiveness shown by the hospital staff. The data can be used to juxtapose the health care experiences of different subgroups to ultimately reduce disparities in health care services. In conclusion, the analysis of the interviews pointed out that the HCAHPS surveys gauge these patients’ experiences well because the concerns of the interviewees align with the majority of the concerns mentioned in the HCAHPS. However, the findings revealed a complex set of unique and important beliefs shared by the interviewed patient population, which indicates that the HCAHPS can add certain categories to reflect the patients’ experiences more accurately. By illuminating low-income patients’ ways of thinking about services provided, this study elucidated the factors that influence the perception of care of a subset of the ED patient population that has not been studied previously.