High income individuals less likely to skip high value care
July 12, 2024
Percentage of adults ages 18-64 using high value care by income (2010-2019)
Source: Park, et al Health Affairs, July, 2024 LINK
Researchers in Health Affairs reported this month on utilization of high and low value care based on income. They found that those with high incomes were likely to use more high value care than those with lower incomes. High value care included cancer screening, blood pressure, cholesterol, HbA1C tests, and eye and foot examinations for those with diabetes.
The researchers found that utilization of low value care differed less based on income. Lower income people were more likely to take antibiotics for influenza, opioids for headache or musculoskeletal pain, and nonsteroidal anti-inflammatories (like Advil) for musculoskeletal pain even if they had high blood pressure, heart failure or poor kidney function. There was little difference based on income for other low value care, including imaging for headache or back pain and valium-like drugs for depression.
Percent of adults ages 18-65 using low value care, by income (2010-19)
Source: Park, et al Health Affairs, July, 2024 LINK
About a quarter of the sample had at least one episode of low value care during the study period (24.7% for those with income under 200% of the federal poverty level (FPL), 24.2% for those with income 200 to under 400% of the FPL, and 24.1% for those over 400% of the FPL.
The researchers did not have access to data on which people were on high deductible health plans, and combined reporting on private insurance and those on Medicaid. The sample was weighted to represent the US population, and data was adjusted for elements that might confound relationship between income and medical utilization, such as age, sex, race, employment status, marital status, and region.
Implications for employers:
- Delivery of low value care remains very common for people of all income levels.
- Many people failed to get high value care. Those with lower income were more likely to omit high value care.
- Campaigns to encourage cancer screening or appropriate care for diabetes should be designed to be compelling to the broad range of employees, including those with lower income who might be most likely to skip high value care.
- Employers can continue to ask carriers for reporting on low value care, and for enhanced efforts to decrease the provision of low value care.
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Coming Monday: Decline in cancer mortality