High-Deductible Health Plans Reduce Usage of Preventative Care

A study finds a disparity in healthcare utilization between low and high-salary employees with high-deductible plans.

Income determines healthcare utilization and spending when it comes to high-deductible health plans (HDHPs), according to a study in the American Journal of Managed Care.

Employees in HDHPs earning less than $75,000 annually have lower rates of usage and spending on preventative care, while having higher rates of acute care utilization, the study found.

"High-deductible health plans shift the cost of care to plan holders," the authors stated. "This can lead to reduced utilization of care. High-deductible health plans have potential negative consequences for individuals earning a low salary."

Researchers used commercial medical and pharmacy claims and administrative data from a large national employer between 2014 and 2018. The employer operates in the healthcare industry and has more than 60,000 employees—the study sample includes utilization patterns for 33,470 employees.

Other highlights of the study include:

• The lowest-salary employees—earning less than $50,000 per year—had 40% higher total medical spending on emergency department care, but less spending on outpatient care and prescription drugs.
   
• Low-salary employees had higher quarterly average spending on inpatient ($500) and emergency department visits ($156) than those in higher-salary groups.
   
• Employees earning more than $100,000 annually were more likely to seek outpatient care and prescriptions compared to those earning $75,000 to $100,000.
   
• Higher-salary employees were healthier relative to lower-salary employees, with a smaller proportion have three or more comorbidities on the Elixhauser Index.

"The utilization and cost results indicate that lower-salary employees utilize care differently than higher-salary employees in a way that suggests suboptimal care-seeking behavior," the authors state.

The study is another example of how social determinants of health contribute to disparities and inequalities in healthcare spending and outcomes.

While HDHPs tend to save employees on out-of-pocket premiums, they in turn expose them to the full cost of care, which can discourage seeking out preventable services.

"This pattern of health care utilization may lead to delayed diagnosis of health conditions and potentially miss the window and benefits of early diagnosis or prevention," the authors conclude.