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Healthcare Beyond Wealth

Healthcare Beyond Wealth: A Comparative Analysis of Socioeconomic Status, Access, and Treatment Outcomes in Sri Lanka and the United States

How Does Socioeconomic Status Influence Access to Healthcare and Treatment Outcomes?


By Manal Fouad


Abstract

This paper examines how socioeconomic status influences healthcare access and treatment outcomes through financial, geographic, educational, and systemic barriers. Research from the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), Healthy People 2030, and peer-reviewed studies demonstrates that lower socioeconomic status is associated with delayed healthcare utilization, reduced use of preventive services, poorer chronic disease management, and worse overall health outcomes.[1][2][3] However, the relationship between socioeconomic status and health is not determined solely by individual wealth. A comparison between Sri Lanka and the United States demonstrates how healthcare policies and system organization can influence the extent to which socioeconomic disadvantage affects health outcomes. Although the United States possesses greater economic resources and higher healthcare spending, significant disparities related to insurance coverage, affordability, and healthcare access remain.[3][4][5] In contrast, Sri Lanka’s universal healthcare system demonstrates that equitable healthcare policies can reduce socioeconomic barriers despite having fewer national resources.[10][11] This paper argues that socioeconomic status significantly influences healthcare access and treatment outcomes; however, effective public health policies and equitable healthcare systems can reduce the impact of socioeconomic inequality and promote greater health equity.


Introduction 

Socioeconomic status (SES) refers to an individual’s or group’s social and economic position within society. It is commonly measured through factors such as income, education, occupation, wealth, and financial stability. SES is recognized as one of the most influential determinants of health because it shapes an individual’s ability to access resources necessary for maintaining well-being. According to the World Health Organization (WHO), social determinants of health are the non-medical conditions that influence health outcomes, including the environments in which individuals are born, grow, live, work, and age. These determinants include economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. Together, these factors influence health outcomes and contribute to differences in health across populations.[12]

Because socioeconomic status affects access to essential health resources, it plays a major role in determining whether individuals receive timely, affordable, and quality healthcare. Persistent socioeconomic inequalities contribute to differences in healthcare access, treatment opportunities, and health outcomes. Understanding these relationships is essential for developing policies that improve healthcare accessibility, reduce disparities, and promote health equity among underserved populations. Health disparities refer to measurable differences in health outcomes between groups, while health inequities describe differences that are considered unfair and avoidable because they result from unequal opportunities and resources. According to the WHO, health inequities are strongly influenced by differences in income, education, employment, housing, and access to healthcare services.[1]

Healthcare is a fundamental component of individual and population well-being. Despite advances in medical technology and healthcare delivery, many individuals continue to experience unequal access to healthcare services due to socioeconomic inequalities. Lower socioeconomic status is associated with several barriers, including financial hardship, transportation challenges, limited health literacy, and reduced availability of healthcare providers. These barriers can delay diagnosis, interfere with treatment adherence, worsen disease management, and contribute to poorer health outcomes.[2][3][6][7][8]

Although wealth is often assumed to determine the quality of a nation’s healthcare system, this relationship is not always straightforward. Sri Lanka provides universal healthcare despite having significantly fewer economic resources than the United States. Nevertheless, it has achieved strong health outcomes, including high life expectancy and low maternal and infant mortality rates.[10][11] In contrast, the United States spends more on healthcare than any other country but continues to experience substantial disparities in healthcare access related to income, insurance coverage, and affordability.[4][5] Comparing these two countries demonstrates that healthcare policies and system organization can significantly influence the relationship between socioeconomic status and health outcomes.


Literature Review

Socioeconomic Status as a Determinant of Health

Socioeconomic status is recognized as one of the most influential determinants of health because it shapes an individual’s access to resources, opportunities, and conditions necessary for maintaining good health. Lower socioeconomic positions are consistently associated with poorer health outcomes and reduced life expectancy, a relationship often described as the “social gradient in health.” This concept demonstrates that health improves with each increase in socioeconomic position rather than only showing differences between the wealthiest and poorest groups. Individuals with greater income, educational attainment, and social resources generally experience longer life expectancy, lower rates of chronic disease, and improved overall health outcomes.[1]

The social gradient in health demonstrates that socioeconomic disadvantage affects health across the entire population rather than only among individuals experiencing extreme poverty. Research has shown that SES influences exposure to health risks, access to healthcare resources, and the ability to engage in preventive health behaviors.[17] Therefore, socioeconomic status remains a critical factor in understanding differences in healthcare access and treatment outcomes globally.


Educational Barriers and Health Literacy

Educational barriers represent another pathway through which socioeconomic status influences healthcare access and treatment outcomes. Education affects an individual's health literacy—the ability to obtain, understand, and apply health information when making healthcare decisions. Limited health literacy is associated with poorer health outcomes, reduced ability to follow treatment recommendations, and decreased use of preventive healthcare services. Individuals with lower health literacy may struggle to understand medication instructions, communicate effectively with healthcare providers, or navigate complex healthcare systems, which can negatively affect disease management.[6]

The relationship between education and healthcare outcomes is further supported by research identifying health literacy as an important pathway connecting socioeconomic status with health disparities. Individuals with lower socioeconomic status often have fewer educational opportunities and reduced access to health information, making it more difficult to engage in preventive care and make informed healthcare decisions. As a result, socioeconomic disadvantages can contribute to delayed diagnoses, poorer treatment adherence, and increased disease burden.[7] These findings demonstrate that healthcare access is influenced not only by whether medical services are available but also by whether individuals have the knowledge and resources necessary to use those services effectively.


Financial Barriers 

One of the most significant ways socioeconomic status influences healthcare access is through financial barriers. People with lower incomes are more likely to experience difficulty paying for medical appointments, diagnostic tests, prescription medications, and other healthcare services. Out-of-pocket healthcare costs often discourage patients from seeking medical care, causing them to delay or forgo treatment altogether.[3][5] Severe medical expenses can also create catastrophic financial hardship, forcing families to borrow money, sell possessions, or reduce spending on essential needs such as food and housing.[9] These findings suggest that financial insecurity not only limits access to healthcare but also perpetuates a cycle in which poor health contributes to economic instability.

The importance of reducing financial barriers is further demonstrated by research examining the effects of Medicare eligibility on healthcare access among adults with different income levels. Gaining health insurance significantly improved healthcare affordability, reduced financial strain, and increased access to necessary medical services, with the greatest benefits observed among lower-income individuals[3]. Participants were less likely to postpone medical care because of cost after obtaining Medicare coverage, demonstrating how insurance coverage can reduce socioeconomic disparities in healthcare access. Together, these studies demonstrate that financial barriers are a primary mechanism through which socioeconomic status influences healthcare utilization. When healthcare costs become unaffordable, individuals are more likely to delay treatment, increasing their risk of poorer health outcomes. Conversely, policies that reduce financial burdens, such as expanded insurance coverage, can improve healthcare access and help narrow disparities between socioeconomic groups.[3][9]


Geographical Barriers

Geographic barriers are another important factor through which socioeconomic status influences healthcare access and treatment outcomes. Individuals living in rural or underserved communities often face limited access to healthcare providers, requiring them to travel longer distances to obtain primary or specialized care. Rural areas frequently experience shortages of physicians, specialists, and mental health professionals, making it more difficult for residents to receive timely and continuous care. As a result, many individuals postpone preventive services or delay seeking medical attention until their conditions become more severe, increasing the likelihood of poorer health outcomes.[3][12]

Transportation further compounds these challenges, particularly for lower-income populations. Lack of reliable transportation is a significant barrier to healthcare access, contributing to missed appointments, delayed treatment, and reduced continuity of care. Individuals without dependable transportation are often unable to attend routine check-ups or follow-up visits, disrupting disease management and increasing the risk of preventable complications. Because transportation barriers disproportionately affect individuals with lower socioeconomic status, they reinforce existing healthcare disparities.[8] Together, these studies demonstrate that geographic location, provider shortages, and transportation limitations interact to restrict healthcare access, ultimately contributing to delayed treatment and poorer health outcomes among socioeconomically disadvantaged populations.

These findings demonstrate that educational, financial, and geographic barriers are interconnected mechanisms through which socioeconomic status influences healthcare access. Therefore, examining healthcare systems provides valuable insight into why countries with different economic resources may experience different relationships between socioeconomic status and health outcomes.




Comparative Analysis: Sri Lanka and the United States of America

U.S.A. Case Study 

The United States of America provides a divided case study, in which greater national healthcare spending does not necessarily guarantee nor grant equal access to medical services. The country has substantial healthcare resources and advanced technology–yet remains strongly influenced by insurance status, income, healthcare costs, geographic location and education.[3][4][5][6]

The truth for lower-income Americans is that these barriers overlap; an individual may lack adequate insurance, struggle to afford medical expenses, live in areas with limited healthcare providers, and/or have difficulty navigating the complexities of the American healthcare system. As a result, socioeconomic status can have a substantial influence on both healthcare access and treatment outcomes in the United States.[3][5][6][7][8]


Sri Lanka Case Study 

Sri Lanka provides the importance of how healthcare policies can reduce the influence of socioeconomic status on access to care. The country supplies universal healthcare, a system that has assisted populations regardless of individual wealth. Although socioeconomic inequalities still exist, and rural areas may experience workforce and service disparities, the publicity of this system reduces financial barriers that would otherwise prevent lower-income individuals from receiving the care needed.[10][11]

Sri Lanka’s experience is particularly significant because it proves that strong healthcare outcomes are not determined by national wealth exclusively, but are due to public investment, universal coverage, primary healthcare, maternal and child health programs, and community based improvements toward population health.[10]11] Therefore, Sri Lanka illustrates that governmental policies can reduce SES disadvantages that become barriers to healthcare. 


Financial Barriers

Socioeconomic status strongly influences healthcare access in the United States because healthcare is closely connected to insurance coverage and the ability to afford medical services. The United States spends more per person on healthcare than other high-income countries, yet high levels of healthcare spending do not eliminate financial barriers for individuals and families.[4] The high cost of healthcare can make medical services, prescription medications, and other necessary treatment difficult to afford, particularly for lower-income populations. As a result socioeconomic status can determine whether individuals are able to obtain healthcare when they need it. 

Healthcare costs can also cause Americans to delay or avoid medical care. The Kaiser Family Foundation reported that healthcare costs are a major challenge for many Americans, with cost being an important reason individuals postpone or go without needed care.[5] These financial barriers disproportionately affect lower-income individuals because they have fewer financial resources to absorb unexpected medical expenses. Insurance status further contributes to this inequality. Research has found that insurance coverage is associated with improved access to healthcare among low-income populations, meaning that gaps in coverage can create additional barriers to receiving preventive and necessary medical care.[3] Therefore, in the United States, socioeconomic disadvantage can directly affect access to healthcare through the combined effects of income, insurance coverage, and healthcare costs.

Sri Lank provides an opposing example—the country has developed a universal healthcare system in which government healthcare services are available to the population with little or no direct cost at the point of service.[10][11] This approach reduces the extent to which an individual’s ability to pay determines whether they can access basic healthcare. Although Sri Lanka has considerably fewer economic resources than the United States, its commitment to publicly funded healthcare has helped reduce financial impediment to healthcare access.[10][11]

Sri Lanka's experience also demonstrates that national wealth alone does not determine healthcare outcomes.[10][11] Despite being a middle-income country, Sri Lanka has, historically, achieved a relatively strong public health indicator. Government investment in publicly provided healthcare, combined with board population coverage has contributed to these outcomes. The comparison therefore suggests that healthcare financing policies can influence the strength of socioeconomic status and its effects on access to treatment. While lower=income individuals in both countries face economic disadvantage, universal public health systems can reduce those financial consequences and disadvantage.[10][11]


Geographical Barriers

Geography represents another important way in which socioeconomic status can influence healthcare access. In the United States, rural communities frequently experience shortages of healthcare providers and limited access to specialized services. Geographic isolation can make it more difficult for individuals to reach physicians, hospitals, and specialists, particularly when transportation is limited. These barriers can be particularly significant for lower-income individuals who may have fewer opportunities for transport or less mobility to travel large distances for medical appointments.[3][8][12]

Healthcare workforce shortages further contribute to geographical inequality. Research on rural healthcare has demonstrated that shortages of healthcare professionals can limit the access and availability of medical services in these rural areas.[12] As a consequence, geographical locations can interact similarly with socioeconomic status: people with greater stability in financial resources may overcome distances more easily than that compared to lower-income individuals who are most likely to depend on healthcare services amiable in their local communities. 

Sri Lanka also experiences these inequalities in healthcare access—primarily in rural and remote areas. Although the country has extensive public health infrastructure, differences in the distribution of healthcare workers and services can create regional disparities. Rural areas generally may face greater difficulties obtaining certain services because healthcare professional and advanced facilities are not distributed equally throughout the country.[11]

However, Sri Lanka’s nationwide public healthcare system helps reduce the effects of geographic and socioeconomic inequality by maintaining public hospitals and primary health care services throughout the country.[10][11] The availability of publicly funded facilities means that people do not necessarily need substantial financial resources to access basic healthcare. Although geographic disparities remain, the national public system provides an important foundation for expanding healthcare access across different regions. 


Educational and Health Literacy Barriers

Education and health literacy represent other important connections between socioeconomic status and healthcare accessibility. In the U.S. individuals with lower levels of education or health literacy may experience greater difficulty understanding medical information, navigating healthcare systems, and making informed decisions about treatment or payment plans. A review by Berkman et al. found that low health literacy is associated with poorer health outcomes and often difficulties in understanding and using information regarding health.[6] Denoting this; socioeconomic disadvantage can affect healthcare not only through income but also through an individual's ability to navigate complex systems. 

This complexity of insurance and healthcare systems can also further increase these difficulties—patients may need to understand insurance plans, deductibles, copayments, provider networks, and eligibility requirements before receiving designated care. Individuals with fewer educational or financial resources may feel significantly challenged navigating these systems. In other words, educational disadvantages make it more difficult for populations to obtain appropriate healthcare.[6][7]

Sri Lanka demonstrates a different approach through its emphasized education regarding public health and community-based programs. Sri Lanka’s public health system has supported maternal and child health programs—contributing improvements and outcomes regarding maternal health.[10] Public health incentives can reduce educational barriers faced otherwise, by bringing health information and preventative services directly into communities rather than requiring people to individually navigate complex healthcare systems. 

The WHO has also highlighted the role of Sri Lanka's public health system in providing population-wide services and promoting health through community-based programs.[10][11] This approach demonstrates that health education can be integrated into a publicly accessible healthcare system. Rather than relying entirely on individuals to seek out and understand healthcare information, public health programs can actively provide education and preventive services to communities.


Comparative Discussion

The comparison between Sri Lanka and the United States demonstrates that SES is an important predictor of healthcare access, but it does not act independently of healthcare policies. In both countries, individuals with fewer socioeconomic resources can experience disadvantages related to geography, education, and access to services. However, the healthcare systems of the two countries differ in strength from these disadvantages; barriers into receiving genuine care.[1][2][3][10][11]

The United States has greater economic resources and significantly higher healthcare spending, but its reliance on insurance coverage and ability to pay can create substantial financial barriers for lower-income populations. Healthcare costs can lead individuals to delay or avoid care altogether—while geographic and educational barriers can further complicate access.[3][4][5][6][8] In contrast, Sri Lanka's universal public healthcare system reduces direct financial barriers and provides a nationwide network of healthcare services despite the significantly limited economic resources in the country.[10][11] This comparison suggests that SES remains an important predictor of health, but equitable healthcare policies can reduce the extent to which socioeconomic disadvantage determines access to treatment and health outcomes within communities. Sri Lanka illustrates that universal healthcare coverage and publicly funded services can weaken the relationship between income and access to essential healthcare with developed programs and functional policies.[10][11] The United States, meanwhile, illustrates how high healthcare spending and advanced medical resources can coexist with significant socioeconomic disparities when affordability, insurance status, geography, and health literacy remain barriers—despite the inefficient processes.[3][4][5][6]

Finally, socioeconomic status influences healthcare access and treatment outcomes through multiple interconnected pathways, specifically; income affects the ability to afford care, geography affects the ability to reach providers, and education and health literacy affect the ability to understand and navigate healthcare systems.[1][2][3][6][7][8] However, the comparison between Sri Lanka and the United States demonstrates that these inequalities are not inevitable. Healthcare policies can either reinforce or reduce the effects of socioeconomic disadvantage. Therefore, improving health equity requires not only addressing individual socioeconomic conditions but also creating healthcare systems that ensure people can receive necessary care regardless of their income or social position.[1][2][10[11]


Footnotes

  1. World Health Organization, “Social Determinants of Health,” May 6, 2025. This source is used throughout the paper for the definition of social determinants of health, the social gradient in health, socioeconomic inequalities, health inequities, and the relationship between income, education, living conditions, and health outcomes.

  2. Centers for Disease Control and Prevention, “Social Determinants of Health (SDOH),” January 17, 2024. This source supports the discussion of social determinants of health, economic stability, education, healthcare access and quality, transportation, and health equity.

  3. Office of Disease Prevention and Health Promotion, Healthy People 2030, “Access to Health Services.” This source supports claims concerning insurance coverage, out-of-pocket costs, delayed or forgone care, provider shortages, transportation barriers, and the relationship between access to healthcare and health disparities.

  4. Centers for Medicare & Medicaid Services, “National Health Expenditure Data.” This source supports the discussion of U.S. healthcare spending and national health expenditures.

  5. Kaiser Family Foundation, “Americans’ Challenges with Health Care Costs.” This source supports the discussion of healthcare costs, affordability, and cost-related delays or avoidance of needed healthcare.

  6. Nancy D. Berkman et al., “Low Health Literacy and Health Outcomes: An Updated Systematic Review,” Annals of Internal Medicine 155, no. 2 (2011): 97–107, doi:10.7326/0003-4819-155-2-201107190-00005. This source supports the discussion of health literacy, healthcare use, treatment understanding, preventive services, and health outcomes.

  7. C. Stormacq, S. Van den Broucke, and J. Wosinski, “Does Health Literacy Mediate the Relationship Between Socioeconomic Status and Health Disparities? Integrative Review,” Health Promotion International 34, no. 5 (2019): e1–e17, doi:10.1093/heapro/day062. This source supports the relationship among socioeconomic status, educational attainment, health literacy, preventive healthcare use, and health disparities.

  8. Samina T. Syed, Ben S. Gerber, and Lisa K. Sharp, “Traveling Towards Disease: Transportation Barriers to Health Care Access,” Journal of Community Health 38 (2013): 976–993, doi:10.1007/s10900-013-9681-1. This source supports the discussion of transportation barriers, missed appointments, delayed care, medication access, and the disproportionate effect of transportation barriers on lower-income and underinsured populations.

  9. Beverley M. Essue et al., “The Effectiveness of Interventions to Reduce the Household Economic Burden of Illness and Injury: A Systematic Review,” Bulletin of the World Health Organization 93, no. 2 (2015): 102–112B, doi:10.2471/BLT.14.139287. This source supports the discussion of out-of-pocket healthcare expenses, financial hardship, catastrophic healthcare expenditure, and the financial protection provided by reducing healthcare copayments.

  10. H. Senanayake et al., “Achieving Millennium Development Goals 4 and 5 in Sri Lanka,” BJOG: An International Journal of Obstetrics & Gynaecology 118, Supplement 2 (2011): 78–87, doi:10.1111/j.1471-0528.2011.03115.x. This source supports the discussion of Sri Lanka’s free medical care, maternal and child health programs, midwifery, and improvements in maternal and neonatal health.

  11. Amala de Silva, Thushara Ranasinghe, and Palitha Abeykoon, “Universal Health Coverage and the Health Sustainable Development Goal: Achievements and Challenges for Sri Lanka,” WHO South-East Asia Journal of Public Health 5, no. 2 (2016): 82–88. This source supports the discussion of Sri Lanka’s state-funded healthcare, free care at the point of delivery, primary healthcare policy, widespread healthcare services, and remaining disparities in healthcare provision and financing.

  12. I. Weinhold and S. Gurtner, “Understanding Shortages of Sufficient Health Care in Rural Areas,” Health Policy 118, no. 2 (2014): 201–214, doi:10.1016/j.healthpol.2014.07.018. This source supports the discussion of rural healthcare shortages and limitations in the availability of healthcare professionals.





References

Berkman, N.D., Sheridan, S.L., Donahue, K.E., Halpern, D.J. and Crotty, K. (2011) ‘Low health literacy and health outcomes: an updated systematic review’, Annals of Internal Medicine, 155(2), pp. 97–107. Available at: https://doi.org/10.7326/0003-4819-155-2-201107190-00005 (Accessed: 6 August 2026).


Centers for Disease Control and Prevention (2024) ‘Social determinants of health’. Public Health Gateway, 16 May. Available at: https://www.cdc.gov/public-health-gateway/php/about/social-determinants-of-health.html (Accessed: 6 August 2026).


Centers for Medicare & Medicaid Services (2025) ‘National Health Expenditure Data’. Available at: https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data (Accessed: 6 August 2026).


Casalino, L.P., Pesko, M.F., Ryan, A.M., Mendelsohn, J.L., Copeland, K.R., Ramsay, P.P., Sun, X., Rittenhouse, D.R. and Shortell, S.M. (2014) ‘Small primary care physician practices have low rates of preventable hospital admissions’, Health Affairs, 33(9), pp. 1680–1688. Available at: https://doi.org/10.1377/hlthaff.2014.0434 (Accessed: 6 August 2026).


Essue, B.M., Kimman, M., Svenstrup, N., Lindevig Kjoege, K., Laba, T.L., Hackett, M. and Jan, S. (2015) ‘The effectiveness of interventions to reduce the household economic burden of illness and injury: a systematic review’, Bulletin of the World Health Organization, 93(2), pp. 102–112. Available at: https://doi.org/10.2471/BLT.14.139287 (Accessed: 6 August 2026).


Kaiser Family Foundation (KFF) (2025) ‘Americans’ challenges with health care costs’. Available at: https://www.kff.org/health-costs/americans-challenges-with-health-care-costs/ (Accessed: 6 August 2026).


Office of Disease Prevention and Health Promotion (ODPHP) (n.d.) ‘Access to health services’. Healthy People 2030. Available at: https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/access-health-services (Accessed: 6 August 2026).


Pallegedara, A. and Grimm, M. (2017) ‘Demand for private healthcare in a universal public healthcare system: empirical evidence from Sri Lanka’, Health Policy and Planning, 32(9), pp. 1267–1284. Available at: https://doi.org/10.1093/heapol/czx085 (Accessed: 6 August 2026).


Syed, S.T., Gerber, B.S. and Sharp, L.K. (2013) ‘Traveling towards disease: transportation barriers to health care access’, Journal of Community Health, 38(5), pp. 976–993. Available at: https://doi.org/10.1007/s10900-013-9681-1 (Accessed: 6 August 2026).


Woods, L.M., Rachet, B. and Coleman, M.P. (2006) ‘Origins of socio-economic inequalities in cancer survival: a review’, Annals of Oncology, 17(1), pp. 5–19. Available at: https://doi.org/10.1093/annonc/mdj007 (Accessed: 6 August 2026).


World Health Organization (2015) ‘The effectiveness of interventions to reduce the household economic burden of illness and injury: a systematic review’. Bulletin of the World Health Organization. Available at: https://www.who.int/publications/i/item/the-effectiveness-of-interventions-to-reduce-the-household-economic-burden-of-illness-and-injury-a-systematic-review (Accessed: 6 August 2026).


World Health Organization (2025) ‘Social determinants of health’. WHO, 6 May. Available at: https://www.who.int/news-room/fact-sheets/detail/social-determinants-of-health (Accessed: 6 August 2026).


de Silva, A., Ranasinghe, T. and Abeykoon, P. (2016) ‘Universal health coverage and the health Sustainable Development Goal: achievements and challenges for Sri Lanka’, WHO South-East Asia Journal of Public Health, 5(2), pp. 82–88. Available at: https://doi.org/10.4103/2224-3151.206257 (Accessed: 6 August 2026).

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