Low-income workers with HSA/HDHPs more likely to skip care

Low-income workers who switch to high-deductible health plans (HDHPs) and health savings accounts (HSAs) are more likely than their higher-paid colleagues to avoid certain types of health care, according to recent research from the Employee Benefit Research Institute (EBRI). The EBRI analysis, which looked at actual health claims of one large Midwestern employer by workers’ income levels, found significant differences for the use of some health services, but not for others.

For example, the report found that switching to an HSA-eligible health plan caused a decline in (nonpreventive) outpatient office visits for workers at all income levels, but the decline was twice as large for workers and their dependents with incomes less than $50,000, as compared with those with incomes of at least $100,000. The decline in specialist visits accounted for most of the decline in outpatient office visits among the group of workers with less than $50,000 in income.

Also, the HSA-eligible health plan was associated with a reduction in various preventive services by worker income, according to EBRI. For example, lower-income workers reduced their use of influenza vaccinations more than higher-income workers. Further, the HSA-eligible health plan was associated with an increase in emergency department visits and inpatient hospital admissions among lower-income individuals.

The usage levels of certain health care services—inpatient hospital days, avoidable emergency department visits, pneumonia vaccinations, HPV vaccinations, and blood sugar testing for individuals with diabetes—were unaffected by enrollment in the HSA-eligible health plan both overall and by worker income.

“A key question with high-deductible HSA-eligible health plans is how the income differences of workers affect the use of health care services and spending: Do lower-paid workers defer health care more than higher-paid workers?” said Paul Fronstin, director of EBRI’s Health Research and Education Program. “We found mixed results: For some health services, yes it does—but for others, it does not.”

SOURCE: EBRI press release, August 30, 2016.

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