The confluence of high-deductible insurance and a low-wage job puts a financial burden on many workers. We might expect that in any event people who make more money use more health care, but income is often correlated with education and other factors that affect how consumers navigate the health system and use health care resources. A study in Health Affairs looks at relative health care use by wage level. (HA Article) The authors used data from 2014 to ascertain utilization patterns from about 43,000 employees at four companies covered through a private exchange. Employees had a choice of multiple plans, including high deductible ones. Wages were divided into four groups, with the lowest group being $30,000 annually and below, and that group was divided into two sub-groups. The highest group had annual pay above $70,000. Average wages were $19030 for the lowest sub-group and $111555 in the highest group. The low-wage group was younger, more likely to be female, and less likely to live in the Northeastern United States. They were twice as likely to be in their first year of employment and much less likely to be salaried, as opposed to hourly, employees. Deductibles were 10% of wages in the lowest wage category, compared to less than 1% in the highest one.
Low-wage workers had a higher burden of chronic illness. But higher wage employees were more likely to have some medical care and the likelihood of receipt of medical care rose through each wage group. However, the lowest-wage workers had the highest use of ER services, three times more than the rate for the highest paid employees. But there was no difference in the use of avoidable ER visits. On the other hand, the highest paid group had the lowest rate of hospital utilization and hospital use was almost twice as high among the lowest paid category. For hospitalization there was similar pattern of relative use in regard to ambulatory care sensitive stays. Recommended preventive screenings were received from a third to half less frequently for the lowest paid compared to the highest paid employees. Overall health spending was greatest for the highest wage group, followed by the lowest paid one, with the middle-pay groups having the lowest. But the spending was different, as the highest paid category had more drug and outpatient spending while the lowest paid used more hospital and ER care.
Almost 30% of US workers makes $30,000 a year or less and another 14% make between $30,000 and $40,000. It is clear that the current makeup of insurance plans disfavors this group, both in terms of premium contributions and deductibles. The best solutions is for employers to voluntarily, or if necessary, by regulation, to scale contributions and deductibles by income level. But lack of knowledge of how to appropriately use health care also plays a role and special attention may need to be given to helping low-income workers learn how to manage their health.