The quality of healthcare matters and it is one of the more difficult things for a consumer/patient to gauge. We can tell if a consumer product is cheaply made, or if a dining experience is sub par. It is harder to observe, research, quantify and compair the quality of healthcare. For most Americans, unless it is a major procedure, or requires services offered at a specialty location, we probably stick close to home. But what if the quality of care close to home is vastly different than even a few hours away?
Another very interesting angle is to consider is if variations in outcomes and quality are not simply in the hands of the provider, but also influenced by socioeconomic factors. Do you have access to high quality food and can you afford it? Do you have access to health education and do you have the means to follow the recommendations? Do work conditions in manufacturing-dominated areas contribute to health issues that aren't as prevalent in professional areas?
This week, the Robert Wood Johnson Foundation released an interactive tool for exploring health outcomes by geographic area. In Virginia, there are some pretty clear relationships between positive health outcomes and medican household income. I've not reviewed enough data to suggest any causalities. For instance, are better care facilities found in more populated areas and therefor those areas have better outcomes? Regardless, the relationship between low income and poor health outcomes is worthy of discussion; particularly as our country continues the debate over national health reform.
New York Times Economic Samples from 2005-2009:
In this case, the colors are inverse. The upper map shows positive health outcomes in white and light green. For instance, Nelson (NE) and Albemarle (AE) counties. The lower map shows higher household incomes in dark green. For instance: Fredricksburg and Charlottesville metropolitan areas.
The relationship is a little more clear if we look at county by county:
|1||Fairfax||City of Calls Church|
|3||Loudoun||City of Alexandria|
|6||Alexandria||City of Fairfax|
|7||James City||James City County|
source: Health - RWJF, Income - Wikipedia.
To be absolutely clear, this is not a scientific study. There are likely many other factors which should be considered including population density, density of qualified healthcare providers, etc. We need to also think about other things that go hand-in-hand with economic disparity. For instance, areas of low income are traditionally associated with fewer healthy options for food and are sometimes classified as food deserts. Areas of high income tend to also have better education, which has a well studied cause and effect relationship to positive health outcomes.
My point in sharing this comparison is simply to call attention to the large variation in health outcomes, even in a single state and to raise the question of socioeconomic factors, as well as variations in clinical quality, as a contributing factor. What do you think?