Based on responses from 1,500 California residents, researchers found that among those whose household incomes fell below 200 percent of the federal poverty line, only about half said the quality of their care was excellent or very good, compared to almost 70 percent of those with household incomes above 200 percent of the poverty line.

The underlying reasons for this disparity, according to the researchers, were not the patients’ income per se but the quality of their relationships with caregivers. 聽Low-income people — who often get their care from resource-strapped community clinics and emergency rooms — tended to see different providers each time they sought care, felt less involved in their own health care decision-making and felt less connected to the facilities where they were treated.

By focusing on improving satisfaction and communicating better with patients, health systems serving low-income populations might deliver better care and ultimately better outcomes — without necessarily spending more money, the researchers said. (The Blue Shield of California Foundation helps to support Kaiser Health News’ coverage of the state.)

“It comes down to customer service,” said . “Instead of worrying about problems that could take years to fix, let’s start working today on communication, information and trust.”

This is cheaper — and possibly more effective long-term — than recruiting extra doctors or investing in high-tech gadgets, Long said.

When health care providers take the time to get to know their patients, earn their trust and use technology to stay in contact, patients feel more engaged in their health, the researchers said. That’s especially important with low-income populations, which tend to have higher rates of 聽budget-busting chronic conditions like diabetes, obesity and heart disease. Making these patients active participants in their care could ultimately help with prevention and costs, Long said.

This philosophy is the cornerstone of the so-called patient-centered medical home, a model of primary care focused on prevention and treating patients with teams of doctors, nurses and other support staff.

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