WASHINGTON -- Even more than finding a job or paying th rent, low-income Americans worry most about paying doctors and hospital bills, according to a new survey of families who make less than $20,000 a year.
The study also found that the nation's poor embrace attitudes toward welfare very similar to those of wealthier Americans.
Health-related concerns accounted for five of the 10 top problems that low-income Americans said they had faced in the previous 12 months, the study found. While 10.6 percent said they had worried about making rent or mortgage payments, 18.3 percent said they were most concerned about paying medical bills. Finding a job was No. 2, and paying rent was No. 8 on the list of 10 top concerns.
The authors of the study said they were surprised by the results because they had expected the poor to list basic needs like food and shelter and problems like crime, drug abuse and violence in their neighborhoods among their top concerns. The last three problems did not even make the list of 10 top concerns.
"This is testimony that the health-insurance crisis has really reached new heights," said Drew E. Altman, president of the Henry J. Kaiser Family Foundation, which paid for the study. The foundation works to improve health care for low-income Americans.
About 80 percent of the interviews were conducted in person at the homes of the respondents, primarily because many low-income people do not have phone service, said Robert J. Blendon, chairman of the Department of Health Policy and Management at Harvard University's School of Public Health and one of the study's authors. The in-home surveys increased the depth of the study, offering a very realistic look at the lives of low-income Americans, Mr. Blendon said.
"In a country fixated on the problems of the middle class, the safety nets are failing" to provide many low-income people with basic needs, Mr. Blendon said.
The National Opinion Research Center, in conjunction with Harvard and the foundation, conducted interviews with members 1,900 low-income households nationwide from February to June 1992. The margin of sampling error was plus or minus 3 percentage points.
The report called for improving existing social programs to help the most disadvantaged and for more "surgical" remedies. For example, it called for some new form of universal health coverage; expanding eligibility for the earned-income tax credit, a cash payment made by the government to low-wage workers; and changes in welfare policy to avoid penalizing people for working.
Because welfare benefits are automatically reduced if a recipient starts working, people often make more money remaining on welfare than they make in a low-wage job.
The report also seeks to dispel misperceptions about the poor.
"Americans' view of the poor is the TV image of drugs and crime and violence and welfare dependency -- a permanent subculture of poverty," Mr. Altman said. "Most are average Americans who are working very hard but can't make ends meet."
The study broadened the definition of the poor to include those who live a notch above federal government's official poverty levels, which are defined as an income of roughly $14,000 a year for a family of four or $12,000 for a family of three.
Sheldon Danziger, a professor of social work and public policy at the University of Michigan, said that people who earn less than $20,000 a year, the poverty threshold used in the study, make up more than a fourth of the population. The "official poor," people who live below federal poverty levels, represent about 13 percent of the population.
"The group most likely to need health care," Mr. Danziger said, "is the millions of families who are not officially counted as poor, where income is too high to get Medicaid and they don't work for firms that are large enough to provide health coverage."
Here are the Top 10 problems poor people face, according to a survey by the Henry J. Kaiser Family Foundation:
1. Paying doctor or hospital bills
2. Finding a job
3. Performing daily duties, due to illness or disability
4. Paying for prescription drugs
5. Buying clothing
6. Health in general
7. Life-threatening illness or death of a family member
8. Paying rent or mortgage
9. Buying food
10. Paying for heat and electricity