High deductibles mean less medical care for lower-income families, survey finds

Lower-income families with high-deductible insurance policies are more likely to delay or forego medical care because of cost than higher-income families, reported a study published Monday in the Archives of Internal Medicine.

The findings are not surprising. But coming at a time when policymakers are working to keep healthcare costs down and outcomes up -- calibrating insurance plans to motivate consumers to be choosier about the medical services they purchase, yet still seek enough care to remain healthy -- the results could yield useful ideas, the researchers wrote.

The team, from the University of Pennsylvania and Harvard, surveyed 434 families enrolled in high-deductible health plans offered by Harvard Pilgrim Health Care, a nonprofit health insurer in New England. High-deductible plans were defined as those with annual deductibles of at least $1,000 for individuals and at least $2,000 for families.

The families selected for the survey had been enrolled in the health plans for at least six months, had at least one child under 18 who was included in their insurance policies and had spent at least $500 per year on out-of-pocket expenses such as visits and drug co-pays. Families with incomes less than 300% of the federal poverty level were considered “lower income.” Those with incomes equal to or greater than 300% of the federal poverty level were considered “higher income.”

Fifty-seven percent of lower-income families reported they had delayed or foregone treatment because of cost, versus 42% of higher-income families, the study reported.

Just over 24% of the lower-income group had delayed care for a child (versus almost 14% of the higher-income group); 51.1% of the lower-income group had delayed care for an adult (versus 34.8% of the higher-income group); and 19.8% of the lower-income group had put off operations or procedures (versus 6% of the higher-income group.)

One surprise in the data, the authors wrote, was that lower-income families did not report that they had a harder time understanding their health plans or communicating with their doctors. Based on prior research, the researchers had hypothesized that lower-income consumers would report more difficulties in these areas.

“These findings suggest that physicians have a central role to play in helping their patients navigate the challenges of decision making in high deductible health plans,” the authors wrote.

The researchers also suggested that if, as expected, new coverage mandates encourage more families to enroll in high-deductible plans (which charge lower premiums than low-deductible options), government “should consider strategies to support patients facing high levels of cost sharing,” or out-of-pocket costs.

“Benefits need to be both effectively designed and conveyed to encourage use of clinical preventive services,” they wrote.