Use of Preventive Care by the Working Poor in the United States

This study examined the association between poverty and use of preventive care medical services among older working adults, using data from the Health and Retirement Study. Although it has been previously established that poverty results in less preventive care, it is unknown whether being part of the workforce ameliorates this effect. Working adults who are poor are more likely to be women, racial and ethnic minorities, less educated, and employed in sales, service, production, and material moving sectors, and are less likely to receive insurance through employers.

Results showed that for several preventive interventions examined, working poor were significantly less likely to receive the intervention than people who were not poor. Older working poor people were 4–11 percent less likely to receive breast and prostate cancer screening, and serum cholesterol screening. This effect persisted after variables such as race, insurance status, marital status and others, were controlled for. For other interventions, such as influenza vaccination and cervical cancer screening, there was no significant difference after adjusting for insurance status and education level. These results are not as strong as expected, likely reflecting the fact that poor working adults do have certain advantages in accessing health services over poor nonworking adults, even if those adults have insurance. For example, employers may offer screening tests for employees, wellness programs, and interaction with individuals from diverse backgrounds and economic status. Also, these findings may indicate that employed adults may have skills and characteristics associated with increased use of preventive care.

This study highlights the importance of employer-based insurance programs, given the lack of a national health insurance program in the United States. The number of working poor is still increasing dramatically in the U.S. for a variety of reasons. Understanding the causal pathways by which poverty prevents use of preventive care, even among employed populations, is vital for an aging population. Older poor people in the U.S. continue to face significant challenges in receiving effective and recommended preventive care.