Despite Coverage, High Costs Limit Health Care Access

By Stephen Miller, CEBS Jun 27, 2013

A significant number of people with employer-provided health insurance have problems accessing affordable health care services, according to research by the nonprofit Employee Benefit Research Institute (EBRI).

Lower-income employees have greater problems with health care access—broadly defined as not filling prescriptions because of cost, skipping doses to make medication last longer, or delaying or avoiding getting health care because of cost.

The report, Use of Health Care Services and Access Issues by Type of Health Plan, was published in the June 2013 edition of EBRI Notes. Its findings are from the 2012 EBRI-sponsored Consumer Engagement in Health Care survey. Acompanion article that draws on the research appears in the June 2013 issue of the journal Health Affairs.

“There have been mixed results when it comes to the impact of consumer-driven health plans on preventive and screening services,” said Paul Fronstin, director of the EBRI’s health and education program. “But we find that access to health care services is an issue across the board.”

Nevertheless, EBRI discovered statistically significant differences in health care access between those with traditional coverage and those in consumer-driven health plans (CDHPs) linked to health savings accounts (HSAs) or health reimbursement arrangements (HRAs). Specifically, the researchers noted that:

  • In 2012, 26 percent to 40 percent of those with employer-provided coverage reported some type of access-to-health-care issue for themselves or family members. Individuals in CDHPs and high-deductible health plans were more likely than workers with traditional coverage to report this problem.
  • Individuals in households with less than $50,000 in annual income were more likely to report access issues.

Among individuals with HRAs or HSAs, very few differences in access issues were found concerning whether companies contributed to the account or the level of employer contribution. However, “the length of time individuals had owned the account had an impact on access issues,” the report noted. Furthermore, “access issues appear to have fallen over time for those holding the accounts for one to two years and three or more years, but not for those with accounts for less than a year.”

Health care analyst Greg Scandlen, in a commentaryon the Health Policy blog, took a critical view of some of EBRI’s findings. For instance, he argued that the researchers “look solely at the numbers of visits without any consideration of the value of the visits … or of replacing some physician office visits with more efficient retail-clinic visits for routine services.” He also noted the importance of educating employees on the effective use of consumer-directed plans and of providing supportive information to those enrolled in plans.

Stephen Miller, CEBS, is an online editor/manager for SHRM.​

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