Report: Poor New Yorkers more likely to have delayed or skipped care during the pandemic

BY AMANDA D’AMBROSIO

The majority of New Yorkers living in poverty who have high health needs faced significant barriers to accessing medical care during the pandemic, a challenge that has the potential to widen disparities even as the city exits the public health emergency, a report by the nonprofit organization Robin Hood and Columbia University says.

Robin Hood, based in Union Square, conducted the survey between October 2020 and May 2021 as a part of the Poverty Tracker, a longitudinal study that assesses poverty and well-being among New Yorkers. The study captures quarterly survey responses from the same households over time, including a sample of 3,000 people at any given time that is representative of the city.

City residents who lived in poverty were more likely to delay or entirely skip care than those who did not. Nearly 50% of people in poverty delayed or skipped care for their physical health, compared with 32% of people without hardship, the report found.

People with economic disadvantages more commonly missed out on care for mental health, the survey said. Approximately 59% of people who experienced financial hardship said they delayed or skipped behavioral health care, the report found.

The recent report, released in April, is the second in a series of three studies that will focus on poverty and health care utilization. This research was funded by the Leona M. and Harry B. Helmsley Charitable Trust.

“When you’re trying to manage health conditions and high health needs in the city, and you’re also coping with economic disadvantage, that leads to a lot of challenges in accessing high-quality and appropriate care,” said Christopher Wimer, principal investigator for the Poverty Tracker and director of the Center on Poverty and Social Policy at Columbia University’s School of Social Work.

Around 2 million New Yorkers have high health care needs, which are defined as multiple chronic conditions, a work-limiting illness, se- vere psychological distress or a combination, according to a report released by Robin Hood last year. Nearly 70% of this group reported material hardships such as poverty, food insecurity or housing instability.

Costs of care and transportation were common reasons why people passed on medical care, Wimer noted. About 1 in 5 people reported that they experienced discrimination in accessing health care, most commonly because of their race or ethnicity.

New Yorkers who live in poverty were more likely to have high health care needs, the survey found. Nearly 50% of people with financial hardships had high health care needs compared with 31% without such hardship.

People who lived in poverty were more than three times as likely to have serious psychological distress and 1.6 times as likely to have a work-limiting health condition.

Wimer said that data around health outcomes among low-income populations allows leaders to be more cognizant of how economic hardships can have serious implications on peoples’ lives, includ- ing how housing instability or transportation barriers can translate to poor health outcomes.

More than 70% of survey respondents reported housing hardships, which included living with pests, using alternative sources of heat such as a kitchen stove or portable space heaters in the winter months, and living in overcrowded households.

Housing issues were more prevalent among people with psychological distress, affecting nearly 90%. This finding outlined the prevalence of housing issues and how they intersect with poverty and health, said Sarah Oltmans, chief of grant strategy at Robin Hood.

Although people in poverty were only slightly less likely to report having health insurance, they more frequently reported going to places like emergency rooms or urgent care settings to get care. Of people facing financial difficulty, 30% said they visited the emergency room in the past six months, compared with 19% of people who did not live in poverty.

“It just speaks to the instability in health care access that so many people faced,” Oltmans said. “Even when they have health insurance, the health insurance may not be adequate. This may be the only option they have.”

Although this data covers the pandemic, Oltmans said that exiting the public health emergency— and specifically re-enrolling millions of New Yorkers on Medicaid—could add to the disruption in care that many have already experienced.

“These numbers were, you know, with relative continuity on health insurance that’s very likely to be disrupted over the coming year,” Oltmans said, noting that it should be a priority to ensure people who are eligible do not experience gaps in coverage.

As state and federal officials halt Covid-19 public health emergencies, data on poverty and health care utilization can inform how to further support people in accessing care, said Tracy Perrizo, program officer at the Helmsley Charitable Trust.

“It’s going to be interesting to see where the shocks are,” Perrizo said. “And as we are emerging from the public health emergency, did they change from before?” ■