High-deductible health plans may discourage routine medical care, study finds

Employees making less than $75,000 have higher rates of acute care utilization and spending but lower rates of primary care spending compared with high-salary employees when high-deductible health plans are present, according to a study published May 9 in the American Journal of Managed Care.

The study 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 residing in all states.The study sample represented utilization patterns for 33,470 employees.

Seven key takeaways:

  • Employees making over $75,000 annually were healthier than lower-salary employees, with a smaller proportion having three or more comorbidities on the Elixhauser Index, a method of categorizing comorbidities.

  • Across salary groups, outpatient care utilization was similar, but low-salary employees were more likely to use inpatient and emergency department care.

  • The lowest-salary employees had 40 percent 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 ($156) visits compared to those in higher-salary groups. 

  • The lowest-salary group (less than $50,000 annually) had more emergency department visits that required emergency department care, suggesting that group may have a higher prevalence of conditions such as chest pain.

  • Those earning more than $100,000 a year were generally more likely to seek outpatient care and prescriptions compared to employees earning $75,000 to $100,000 per year.

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