Lower-Income Families Often Defer Healthcare Because of Cost

Lower-income families covered by health plans with high deductibles are more likely to defer care than their counterparts who earn more money and have similar coverage.  A survey of 141 families whose income levels were less than 300 percent of the U.S. poverty rate and 273 families with high incomes found that 51 percent of the poorer families deferred healthcare because of the cost, compared with 35 percent of the better off families.  The study, which was led by Jeffrey Kullgren, a clinical scholar at the Robert Wood Johnson Foundation, which is affiliated with the Philadelphia VA Medical Center and the University of Pennsylvania, was published in a recent edition of the Archives of Internal Medicine.  A 22-item questionnaire collected data about health plan characteristics, attitudes towards use, cost and sought information about behavior and demographics.

One way in which a growing number of families are facing higher levels of cost-shariing for healthcare is enrollment in high-deductible health plans.   These plans, which feature annual deductibles of at least $1,000 per individual and at least $2,000 per family before more services are covered, seek to encourage patients to become more cost-effective consumers of healthcare and frequently offer lower premiums than other types of health insurance.”

Those surveyed were asked how they might respond to three hypothetical scenarios involving services that their plans did not cover – a $100 blood test; a $1,000 colonoscopy; or a $2,000 MRI.  The majority of participants – no matter their income level – would talk with their physician about deferring or making other plans in all three scenarios.  Rather surprisingly, though, the lower-income families were more likely to discuss the $100 blood test of $1,000 colonoscopy than were the higher-income families.

“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,” according to the authors.  “Beyond the implications for clinicians, our findings have important implications for federal health reform.  Reform legislation that establishes an individual health insurance mandate could lead more families to enroll in plans with high levels of cost-sharing, as has been seen following the implementation of coverage mandates in Massachusetts.  If more families do enroll in high-deductible health plans, policymakers should consider strategies to support patients facing high levels of cost sharing.”

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