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New Book Documents Link between Poverty and High Healthcare Costs

New Book Documents Link between Poverty and High Healthcare Costs

“Poverty and the Myths of Health Care Reform” Frames Need for Healthcare Policy to Grapple with Pervasive Impact of Social Determinants


Boston, August 23, 2016 — The Physicians Foundation today announced the release of Poverty and the Myths of Health Care Reform, a thought-provoking and data-rich book documenting the impact of social determinants on healthcare costs. Authored by the late Richard (Buz) Cooper, M.D., the book draws on decades of health research and economic data to demonstrate the pervasive, debilitating effects of poverty on healthcare costs, resource utilization and overall patient outcomes. The book, now available, is published by Johns Hopkins University Press.

“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. “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. Insights from this book should help all healthcare stakeholders, including legislators, acknowledge the tangible impact of poverty on costs, outcomes and society as a whole.”

Dr. Cooper’s book was commissioned by The Physicians Foundation, a nonprofit organization seeking to empower physicians to lead in the delivery of high-quality, cost-efficient healthcare. To hear more insights from Dr. Valenti as well as other colleagues, friends and family about Dr. Cooper’s findings and life, view their video commentary here.

Healthcare Through the Lens of Poverty

Throughout the book, Dr. Cooper builds an engaging and impassioned exploration of healthcare through the lens of poverty, utilizing an array of relevant research. This includes data sets drawn from city, state and federal levels, domestic and global economic assessments, and healthcare utilization statistics and reports.

His work takes both a macro and micro view, zooming in on specific cities or regions to uproot conventional policy assumptions – including those framed by the Dartmouth Atlas of Health Care.

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

Based on the distribution of household incomes throughout the U.S., Dr. Cooper estimates that 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. Even more striking, he reminds readers that life expectancy in poor neighborhoods is a full 10 years shorter than in the richest.

Dr. Cooper also observes that despite America’s overall wealth, 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 (OECD), particularly on services for children and younger adults.

According to Dr. Cooper:

“…care is inefficiently and redundantly used by low-income populations, whose costs are subsidized within states and cross-subsidized among states. 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.”

The Myths of Healthcare Reform

The dominant emphasis of healthcare reform over recent decades has been on eliminating perceived waste and inefficiency. Dr. Cooper challenges this paradigm, documenting how ignoring the impact of low income on healthcare utilization has led policy makers to miss the bigger and more relevant picture – and to reshape clinical practice in ways that impede providers who care for the poor. By illuminating the geographic patterns of poverty, wealth and healthcare spending, he analyzes the impact that regulatory interventions have had on clinical practice, physician wellness and on our nation’s collective health.

“The message that I hope the readers will take to heart is the need to take action now,” said Michael Johns, M.D., and Executive Vice President for Health Affairs Emeritus at Emory University. “If we don’t address the healthcare needs of those living in poverty now, we’re leaving a burden for future generations. This is America. We have to take care of all of our people.”

About the Author

A prominent physician and academic, Richard (Buz) Cooper, M.D. (1936–2016), spent his professional life dedicated to investigating the increasingly prominent role poverty plays in accessing affordable, quality-oriented care. He was a senior fellow at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, the dean and executive vice president of the Medical College of Wisconsin, where he founded the Institute for Health and Society, and the cofounder and director of the University of Pennsylvania Cancer Center.

About Johns Hopkins University Press

Founded in 1878, The Johns Hopkins University Press, recognized as one of the world’s finest and most accomplished scholarly publishers, publishes over 80 scholarly periodicals and more than 200 new books each year.

About The Physicians Foundation

The Physicians Foundation is a nonprofit 501(c)(3) organization that seeks to empower physicians to lead in the delivery of high-quality, cost-efficient healthcare. As the U.S. healthcare system continues to evolve, the Physicians Foundation is steadfast in its determination to strengthen the physician-patient relationship, support physicians in sustaining their medical practices and help practicing physicians navigate the changing healthcare system.

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