07/20/2024

Diversity Corner: PAs Caring for Ohioans in Poverty

By Sean Kramer, MSHS, PA-C, Lake Erie College PA Program Director
OAPA Diversity Committee member

Every day, thousands of Ohio citizens ask themselves whether they can afford healthcare. They must make daily decisions to address what is most important, whether housing, food, bills, or medical care. According to the United States Census Bureau in 2023, about 13% of Ohioans are considered below the poverty line, with some cities at around 50%. These individuals are facing even harsher decisions with recent inflation and deciding which basic needs they must prioritize. The intention of this article is to bring attention to the  challenges for individuals with limited financial means and strategies for physician assistants to help.

Poverty affects people of all genders, races, and ethnicities. However, it disproportionately impacts minority populations at higher rates. Although Medicaid offers no cost medical care, many people slip through.  In addition, many people are considered “working poor,” falling below 200% of the poverty line where it is still difficult to make ends meet. These individuals do not qualify for free care and are often underinsured with high deductibles they cannot afford. While poverty is complex, it is considered a primary driver in the social determinants of health. According to the American Academy of Family Physicians, individuals with poverty and low-income status have had improvements in healthcare outcomes.  However, it is still “associated with various adverse health outcomes, including shorter life expectancy, higher infant mortality rates, and higher death rates for the 14 leading causes of death.”

As physician assistants, a patient’s socioeconomic status should not necessarily be at the forefront of our  care. It is good practice to understand why a patient wants care and hear their problems without them feeling judged for their income status. However, discussing financial barriers can help PAs and patients work together in a few areas during a visit, especially during the medical history and management planning.  

A nonjudgmental approach to consider is asking if there have been any barriers to previously obtaining care. You may learn that they have missed appointments, not been able to take medications, or have procedures due to concerns of cost. For generating plans, providers often have various choices in how we can manage health conditions. We can share options of treatment, which may include more expensive brand medications or lower cost generic drugs or screening tests versus more invasive or expensive testing. When we share options, it gives patients a chance to be empowered in their decisions and to address barriers to care like
financial means. These discussions can also ensure understanding, addressing health literacy barriers, and lead to more motivation in achieving optimal health.

While healthcare outcomes have gotten better for individuals and families with limited financial means, there is room for improvement. As PAs, we are on the front lines. We are well-positioned to understand each patient’s unique obstacles to better health and help overcome them.