Poor Minnesotans tend to receive poorer health care — poorer asthma management, for example, and less blood pressure control — according to a new state report that rates clinics.
But two areas in which low-income Minnesotans fare “better” are equally telling about medicine’s treatment of the rich and the poor.
Children from low-income families covered by state Medicaid programs received better care for upper respiratory infections in 2015 — because doctors were less likely to give them inappropriate antibiotic prescriptions than children with other health insurance, the report showed.
In other areas of health care, the problem is that low-income patients are less likely to receive, afford or take treatments. In this instance, not taking medications is the solution, but the underlying root disparity appears the same.
“There is no biological reason why that should happen, and quite frankly no system reason … either,” said Jim Chase, president of Minnesota Community Measurement, which published the report. “It’s really not a patient choice, though I think if you talk to clinicians they might say, ‘Well, higher income people are advocating for [an antibiotic prescription] more, and so sometimes they get it when they shouldn’t.’ But that’s not a good reason.”
Parents in some cases have lobbied their doctors for antibiotics because of school or day care rules that require sick children to be on antibiotics for 24 hours before they can return to class. But in the case of a viral respiratory infection, antibiotics do no good. And excessive prescribing raises the troubling prospect of bacteria that have become resistant to antibiotics.
The other area in which low-income patients received a higher rate of appropriate care last year was screening sexually active young women for chlamydia. While 56 percent of these women covered by Medicaid were screened, 47 percent with other insurance were screened. Chase said this appears to reflect a long-standing stereotype that the infection is a bigger problem among minorities or low-income Minnesotans.
The good news is that the gap in screening has narrowed over the last seven years as health officials have recognized that chlamydia is a threat to all demographic groups.