High Deductible Health Plans Are Widening Racial Health Gaps.
The growing Black Lives Matter movement has brought more attention to the myriad structures that reinforce racial inequities, in everything from policing to hiring to maternal mortality.
Now, a new School of Public Health study points to a previously-unidentified factor widening the racial health gap: high deductible health plans.
Published in JAMA Network Open, the first-of-its-kind study finds that Black cancer survivors on high deductible health plans face more cost-related barriers to care than white cancer survivors on the same plan, including needing to skip a medication or delay a refill to save money, and not being able to see a specialist.
For example, 22.8 percent of Black versus 8.0 percent of white cancer survivors on high deductible plans skipped medication to save money. But among cancer survivors on other kinds of plans, 7.7 percent of Black versus 5.4 percent of white patients skipped medication.
“As enrollment in high deductible health plans continues to rise, this has really concerning implications for racial equity among cancer survivors,” says study lead author Megan B. Cole, assistant professor of health law, policy & management. High deductible plans now cover nearly a third of all people who have employer-sponsored health insurance, and half of cancer survivors with private insurance.
“Enrollment in HDHPs may compound the many structural inequities that Black cancer survivors are already facing, which may further drive disparities in health outcomes for survivors,” Cole says. “Policies that limit deductible sizes and extend cost-sharing subsidies to high-risk groups, while limiting the types of services to which a deductible applies, may help to mitigate observed effects.
“But more broadly, we need policies that really tackle the structural inequities and institutional racism that lie at the root of these disparities.”
Cole and colleagues used National Health Interview Survey data from 2013 through 2018 on 3,713 adults with a past or current cancer diagnosis, and analyzed the relationships between race, health plan type, and eight common indicators of difficulty accessing care and medicine.
In addition to the disparity in skipping medication, the researchers found that 24.6 percent of Black versus 8.6 percent of white patients on high deductible plans took less medication to save money, compared to 8.5 percent of Black and 5.4 percent of white patients on other types of plans; 28.1 percent of Black versus 7.7 percent of white patients on high deductible plans delayed filling a prescription, compared to 16.2 percent of Black and 7.1 percent of white patients on other types of plans; and 14.9 percent of Black versus 6.2 percent of white patients on high deductible plans were unable to afford to see a specialist, compared to 4.9 percent of Black and 2.9 percent of white patients on other plans.
The researchers found that the percentage of privately-insured cancer survivors on high deductible plans rose from 37 percent in 2013 to 50 percent in 2018.
The study was co-authored by alum Jacqueline Ellison (SPH’20); and by Amal N. Trivedi of Brown University School of Public Health.
Comments & Discussion
Boston University moderates comments to facilitate an informed, substantive, civil conversation. Abusive, profane, self-promotional, misleading, incoherent or off-topic comments will be rejected. Moderators are staffed during regular business hours (EST) and can only accept comments written in English. Statistics or facts must include a citation or a link to the citation.