Low Wage Workers and Barriers to Timely Primary Care

Abstract

Introduction: Lower wage workers use less primary care and more acute care, including emergency department (ED)- and hospital-based care. Clinically modifiable barriers to timely primary care services have been associated with increased acute care use. This study aims to determine the association between low-wage work and clinically modifiable barriers to timely primary care. Methods: From the 2011 to 2015 National Health Interview Surveys, I examined data from 50,535 respondents who reported working full-time and had an established outpatient provider and no change in health care coverage in the past year. I compared self-reported delays in care due to four barriers across seven groups of self-reported earnings: <$25,000, $25,000-34,999, $35,000-44,999, $55,000-64,999, $65,000-74,999, and >$75,000. The four barriers included phone availability, appointment wait-time, in-clinic wait-time, and limited clinic service hours. I estimated multivariable logistic regression models, controlling for age, sex, education, insurance coverage, underinsurance, family size, and occupation. All models accounted for survey sampling methods and were weighted to the national population. Results: I identified no difference in barriers to timely care between lowest (<$25,000) and highest (>$75,000) earnings groups of full-time workers. Compared to individuals earning $75,000 or more, individuals earning $65,000-74,999 were more likely to report at least one barrier to primary care (OR 1.22; CI 1.02-1.45; p=0.027); however, this association was not observed for each of the four individual barriers. Furthermore, I did not identify significant differences when compared to the lower wage groups. Conclusion: Among full-time workers with an established outpatient provider, the propensity to delay care due to phone availability, appointment wait-time, in-clinic wait time, or service hours was not different between the highest and lowest wage earners. These modifiable barriers are unlikely to explain the marked differences in acute care use among low-wage workers identified in prior studies.