Poverty, lack of access are major drivers in healthcare spending, says new book by late Richard Cooper, MD

Richard Cooper, MD

If the poorest areas utilized healthcare at the rate of the most affluent, overall utilization and spending could be as much as 30 percent less, according to a new book published by the late Richard Cooper, MD.

Commissioned by nonprofit group The Physicians Foundation, the book, "Poverty and the Myths of Health Care Reform," examines healthcare through the lens of poverty, utilizing data sets drawn from city, state and federal levels, domestic and global economic assessments, and healthcare utilization statistics and reports.

The research takes both a macro and micro view, honing in on specific cities and regions to uproot conventional policy assumptions, including those framed by the Dartmouth Atlas of Health Care.

[Also: Poverty plagues readmissions, study finds, as providers face steep penalties]

One example is the use of New York City's subway system in the first chapter. Cooper follows the A train to map healthcare utilization and costs, to changes in wealth among the populations along its route. The work examines other cities such as Milwaukee, Wisconsin, Grand Junction, Colorado, New Haven, Connecticut and Calgary, Alberta, Canada, to further develop its argument.

While finding that utilization and spending could dip by 30 percent by addressing poverty issues, Cooper notes that the U.S. spends less on social services than is the norm among other developed countries of the Organization on Economic Co-operation and Development, particularly on services for children and younger adults -- despite the country's wealth.

"(C)are is inefficiently and redundantly used by low-income populations, whose costs are subsidized within states and cross-subsidized among states," Cooper said in his research. "By failing the 50 percent of children who are born into poverty, and by tolerating the poverty into which they are born, our nation bears a burden of healthcare spending that is higher than in any other developed country."

[Also: At clinic, poverty magnifies health problems]

The findings challenge the notion that healthcare reform should primarily be focused on eliminating perceived waste and inefficiency. Ignoring the impact of low income on healthcare utilization, Cooper said, has led policymakers to reshape clinical practice in ways that impede providers who care for the poor.

"The essential truths uncovered in Buz's work are very clear from my own medical practice," said Joseph Valenti, M.D., FACOG, and Physicians Foundation board member, in a statement. "Poverty has become one of the most challenging issues we face here in the U.S., particularly with the financial burden it places on our healthcare system in comparison to other developed nations."

"If we don't address the healthcare needs of those living in poverty now, we're leaving a burden for future generations," said Michael Johns, M.D., executive vice president for health affairs emeritus at Emory University, in a statement. "This is America. We have to take care of all of our people."

Twitter: @JELagasse