Low-income non-white patients delay care using HDHP, study finds
The use of high-deductible health care plans (HDHP) has increased in recent years as employers shift costs onto workers. While these plans are believed to reduce unnecessary use of healthcare resources (HCRU), concerns have been raised about whether employees truly understand these plans, especially those on low incomes, as well as whether the plans deter people from seeking preventative care, from filling their prescriptions. , and more.
A poster presentation at the Academy of Managed Care Pharmacy 2021 meeting examined the impact of HDHP on access to care and HCRU in the United States and the interplay between race, ethnicity and status. returned.
Researchers conducted a focused 10-year review using Medline / EMBASE, trade publications, and the Internet. In addition to reviewing data describing the impact of HDHP on health outcomes related to access to care, such as postponement of care due to cost, or an effect on medication adherence and clinic visits doctor, the researchers also wanted to see if socio-demographic status is a factor.
Data were grouped according to outcomes such as medication adherence and access to care and stratified by race, ethnicity and income level.
Thirteen articles, 1 abstract and 10 reports were reviewed and, in line with other concerns, the review found that HDHP not only reduced some of health care utilization as well as access to care, but was also linked to an increase in high intensity and treatment costs, such as emergency room visits and hospitalizations.
Some of the studies have focused on all therapeutic areas, while others have focused on chronic diseases such as diabetes, cardiovascular disease, and chronic obstructive pulmonary disease. One focused on cancer.
Overall, people with HDHP were more likely to report delaying needed medical care, having financial barriers, having claims rejected by insurance, having difficulty finding a provider, or being unable to obtain an appointment. This effect was greater in low-income patients.
Patients with diabetes and HDHP had the fewest specialist visits, compared to patients with low or no deductible. Another study found that the plans were tied to stopping brand-name drugs, while a diabetes study found that low-income patients had a higher level of more intensive healthcare use.
Three studies looked at the impact of race / ethnicity on access to care and HCRU and found that non-white cancer survivors had lower adherence. Non-white survivors used less medication, delayed filling prescriptions, and were more often unable to afford specialists compared to white survivors.
The authors noted that the review was not systematic and that some references may have been missed. In addition, the interaction between race / ethnicity and income / socioeconomic status on the association between HDHP use and access to health care or care has not been discussed. .
The authors wrote that while it is possible that the decrease in HCRU could be due to factors other than HDHP conception, their work suggests that more research is needed to assess the impact of race, ethnicity and income while taking into account other socio-demographic factors on the association between HDHP and health outcomes related to access to care.
Szabo SM, Kuti E, Friesen E, Pimple P, Corepal R, Donato B. Disparities in health care utilization among those with high deductible health plans: a focused review. Presented at: The Academy of Managed Care 2021; April 12-16, 2021. Poster E2.