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| This exhibit shows that high wage workers are more likely to have any claims at all. One could infer that deductibles were discouraging low wage workers from entering the system much more than they discourage high wage workers. |
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| Low wage workers are most likely to have no claims at all. One could infer that deductibles discouraged low wage workers from entering the system much more than they discouraged high wage workers. |
Researchers from Case Western report on differences between medical utilization of lower and higher wage workers in this month's Health Affairs - and the results are disheartening. (H/T to Michelle Andrews of Kaiser Health News who reported on this study today).
Using claims from about 43,000 covered employees over a single year (2014) and four self-insured employers who offered a combination of high deductible and preferred provider organization plans, researchers found
…the lowest-wage group had half the usage of preventive care (19 percent versus 38 percent), nearly twice the hospital admission rate (31 individuals per 1,000 versus 17 per 1,000), more than four times the rate of avoidable admissions (4.3 individuals per 1,000 versus 0.9 per 1,000), and more than three times the rate of emergency department visits (370 individuals per 1,000 versus 120 per 1,000) relative to top-wage-group earners.
Low wage workers also had the lowest medication possession rates. The researchers report that annual deductibles were about 10% of average income for lowest wage quintile, and 1% of average income for highest wage quintile.
The charts below show that avoidable emergency department use was highest in low wage workers, while use of preventive care was highest in high wage workers The bottom graph might look confusing at first- the orange bar represents costs per patient who had any claims at all; the purple bar uses a denominator of all members including the roughly 20% who incur no medical claims.
Note in last graphic that purple uses all members as denominator, and orange uses only those members who had medical claims
There's a lot that this study does not show. The researchers didn't focus on out of pocket expenses - so we don't get a sense of which health plans were "better" or "worse" for lower wage workers. They only evaluated employee (not dependent) care, and had no access to spouse income so some families could be mislabeled as to their total income. One can't impute what level of health care spending is "optimal," and we certainly can't assume that the additional preventive care delivered to higher wage employees was in any was causal of lower emergency department and inpatient costs.
Employer sponsored health insurance (ESI) once promoted increased economic equity. With insurance, those of modest wages could "afford" the same cure of cancer or treatment of a heart attack as their wealthy colleagues. ESI has always offered more benefits to higher wage workers, though, as the tax deductibility is worth little for those at the bottom end of the wage scale.
Years of "consumerism" and decreasing employer subsidies have chipped away at affordability of elective care at the site of service - and this has probably decreased delivery of high value preventive services more to those with the lowest wages.
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