Income and illness.

Little research has been directed toward an examination of the health needs of low-income Americans in relation to major governmental medical care programs designed originally to narrow the health gap between "poor" and "nonpoor." Analysis of unpublished data from the 1977 Health Interview Survey of the National Center for Health Statistics shows that about 75 per cent of the gap in restricted activity days and bed disability days--two common measures of the impact of ill-health--between "poor" and "nonpoor" populations is attributable to greater prevalence and severity of activity-limiting chronic conditions among low-income people. Although both income groups report similar types of chronic conditions resulting in activity limitation, the prevalence of all major chronic conditions is greater in the low-income population. Approximately 25 per cent of the low-income population bears the burden of these conditions; the majority of the "poor" report disability day levels similar to the "nonpoor." The substantial impact of chronic conditions should be an important consideration in meeting the health needs of the low-income population. Current government programs, such as Medicare and medicaid, however, are designed primarily to pay for acute care received in hospitals and in physicians' offices.