Some Insured Workers Delay Healthcare

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Stark differences are emerging in the ways that workers, depending on how much they earn, are using the medical services covered by their employer health plans.

While higher-income workers gravitate toward preventive and maintenance care, lower-wage workers visit emergency rooms far more often, according to a study published last month in Health Affairs.  The researchers pointed to one major culprit: a 67 percent increase in average deductibles for employer health plans since 2010.

Employers usually offer the same health plans to all their employees. But the growing prevalence of high-deductible plans could be making making some low-wage workers think twice before seeing a doctor if they’ll have to pay the entire bill because they haven’t hit their yearly deductibles yet. Health insurance premiums and other out-of-pocket medical costs in high-deductible plans together consumed about 21 percent of pretax earnings for the low-wage workers studied.

Many of these workers, apparently trying to contain their out-of-pocket costs, might “avoid or delay health care services, despite having coverage,” said the researchers.

They analyzed four employers that covered some 43,000 workers through a common private health insurance exchange in 2014.  The researchers adjusted the data so they could compare the employees, controlling for, among other things, health insurance plan design, deductible levels, employee characteristics, and the size of their households.

An analysis of insurance claims data found that lower-paid workers were more likely to see a doctor after medical problems develop, while higher-paid workers were more diligent about preventing problems.

For example, workers in the top two wage categories ($44,000-$70,000 and over $70,001) received preventive care during visits to the doctor’s office far more often than workers earning under $30,000.  Screenings for breast, cervical and colon cancer were also more frequent among high-paid employees, who also adhered more closely to the drug regimens prescribed by their doctors.

Not surprisingly, hospital admission rates for lower-wage workers were nearly double the rates of the highest-paid workers – and four times higher for avoidable medical problems that landed them in the hospital. Low-paid workers visited emergency rooms about three times more often.

There are many potential reasons for these differences, including low-paid workers’ generally lower education levels and less access to paid time off from work to see a doctor. But the researchers said financial constraints certainly played a role:

High-paid employees had the resources to address health concerns “before they became serious, therefore avoiding either emergency department or inpatient care.”

The irony is that, in the end, the lowest paid employees – and their employers – didn’t save much money.  Their reactive medical care cost nearly as much, per employee, as the extensive care used by top earners, the study found. The middle two income groups paid less than employees at the top and bottom of the wage scale.

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Chuck Miller

Studies show lower income people don’t use preventive care even when it’s paid 100% by the employer. It’s not the cost of care, it’s the awareness of employees.

Employers have spent billions on 401k education and precious little on healthcare education. Many employees have no idea what is in their healthcare plan and the best way to use it.


I’m paid decently, but frugality discourages me from going to the doctor. Most likely whatever is ailing me will go away, so why use that valuable HSA money I’ll need when I get cancer? Even for preventive care that is probably covered will likely result in a struggle with insurance and the doctor to actually cover it. A 15 minute doctor visit could result in hours of phone calls fighting bills. This is the first year I didn’t have to go to HR to have them tell our insurance company that flu shots are covered 100%.

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