Racial Inequality Highly Prevalent in High Deductible Health Plans

Black cancer survivors on high deductible health plans (HDHPs) are more likely to struggle financially than their white counterparts, a new study found.

The Black Lives Matter movement has brought increased attention to the myriad of structures in health care that reinforce racial inequalities, according to the press release. A new study by Boston University School of Public Health (BUSPH) examined a previously unidentified factor in particular—HDHPs. According to the press release, these plans cover one-third of people with employer-sponsored health insurance and half of all cancer survivors with private insurance.

The study, which was published in Jama Network Open, used data from the National Health Interview Survey between 2013 and 2018. The data included 3713 adults with a past or current cancer diagnosis. According to the press release, researchers analyzed the intersection and relationship between race, health plan type, and 8 indicates of difficulty accessing care and medicine.

The researchers found that 24.6% of black patients on HDHPs took less medication in order to save money, according to the press release. This is in stark contrast to the 8.6% of white patients on similar plans. On other plans, 8.5% of black patients took less medication compared with 5.4% of white patients.

Researchers also found that 28.1% of black patients and 7.7% of white patients on HDHPs delayed filling a prescription in order to save money, according to the press release. This is much higher than the 16.2% of black patients and 7.1% of white patients on other types of plans. Black individuals on HDHPs were also more likely to be unable to afford to see a specialist. Further,14.9% of black patients on high deductible plans were unable to afford a specialist compared with 6.2% of white patients. On other types of plans, 4.9% of black patients and 2.9% of white patients could not see a specialist for financial reasons.

"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… 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," study lead author and assistant professor of health law, policy and management at BUSPH, Megan B. Cole, PhD, said in the press release.

According to the press release, cancer survivors with high deductible plans are on the rise. In 2013, 37% of survivors were on HDHPs. In 2018, that number rose to 50%.

Reference

BU study: High deductible health plans are widening racial health gaps (News Release); Boston, MA; June 24, 2020; EurekAlert!; Accessed June 25, 2020.