Low-Income, Non-White Patients Delay Care Using HDHPs, Study Says

April 15, 2021
Allison Inserro

A poster at the Academy of Managed Care Pharmacy 2021 meeting examined the impact of high-deductible health plans (HDHPs) on access to health care and resource use in the United States and the interaction of race, ethnicity, and income.

The use of high-deductible health plans (HDHPs) has increased in recent years, as employers shift costs to workers. While these plans are thought to reduce unnecessary health care resource utilization (HCRU), concerns have been raised as to whether employees truly understand these plans, especially those with lower incomes, as well as whether the plans deter people from seeking preventive care, filling prescriptions, and more.

A poster presentation at the Academy of Managed Care Pharmacy 2021 meeting examined the impact of HDHPs on access to care and HCRU in the United States and the interaction of race, ethnicity, and income.

Researchers performed a 10-year targeted review using Medline/EMBASE, trade publications, and the internet. Besides examining data describing the impact of HDHPs on health outcomes related to access to care, such as deferring care due to cost, or affect on medication adherence and physician visits, the researchers also wanted to see if sociodemographic status is a factor.

Data were grouped by outcomes such as medication adherence and care access 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 not only that HDHPs reduced some health care use as well as access to care, but also was linked to increased high-intensity and high-cost treatment, such as emergency department visits and hospitalizations.

Some of the studies focused on all therapeutic areas, while others focused on chronic conditions such as diabetes, cardiovascular disease, and chronic obstructive pulmonary disease. One focused on cancer.

Overall, individuals in HDHPs were more likely to report delaying necessary medical care, have cost barriers, have claims rejected by insurance, have challenges finding a provider, or were unable to get an appointment. This effect was greater for patients with lower incomes.

Patients with diabetes and HDHPs had the fewest number of specialist visits, compared with patients with a low deductible or no deductible. Another study found the plans were linked with the discontinuation of branded medications, while a diabetes study found that low-income patients had a higher level of more intensive health care usage.

Three studies examined the impact of race/ethnicity on access to care and HCRUs and found that non-White cancer survivors had poorer adherence. Non-White survivors used less medication, delayed filling prescriptions, and were more frequently unable to afford specialists compared with White survivors.

The authors noted that the review was not systematic, and 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 care or health care was not discussed.

The authors wrote that while it is possible that decreased HCRU may stem from other factors besides the design of HDHPs, their work suggests that additional research is needed to evaluate the impact of race, ethnicity, and income while considering other sociodemographic 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 use of healthcare among those with high deductible health plans: a targeted review. Presented at: The Academy of Managed Care 2021; April 12-16, 2021. Poster E2.