Introduction
High-deductible health plans are often touted to motivate patients to become informed
healthcare purchasers; however, racial/ethnic minorities report that high deductibles
prevent them from seeking the needed care. One proposed way to mitigate the financial
burden of high-deductible health plans is the use of health savings plans. This cross-sectional
study investigates whether chronically ill Blacks and Hispanics enrolled in high-deductible
health plans experience greater access to care difficulties than non-Hispanic Whites
and whether racial/ethnic disparities are mitigated by the use of health savings plans.
Methods
Weighted, multivariate, linear probability regression models were estimated (analyses
were conducted in December 2020), adjusting for individual attributes and contextual
factors that may explain the variation in health care access. Chronically ill, U.S.-born
Black, Hispanic, and White adults enrolled in a high-deductible health plan from the
National Health Interview Survey in 2011–2018 were included. Associations were tested
among 3 independent variables—being Black, being Hispanic, and health savings plan
utilization (and their interaction)—and access to healthcare outcomes of interest,
including affordability-related access, provider-related access, and delayed care.
Results
Blacks and Hispanics were less likely to use health savings plans, and Blacks were
more likely to experience problems with access to health care. Although the use of
health savings plans was found to have a minimal effect on reducing racial/ethnic
disparities in affordability-related access, there was also evidence that health savings
plans compounded racial/ethnic disparities in provider-related access.
Conclusions
Understanding how health savings plans function to improve access to care within racial/ethnic
minority groups may help to inform policy approaches related to their use.
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Article Info
Publication History
Published online: May 11, 2021
Identification
Copyright
© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
