There are countless studies about all aspects of health insurance, population health, health studies of all types, but there has not been much consideration given to how income impacts health utilization within the context of employer health plans. This abstract from an important Health Affairs article in February 2017, by Bruce Sherman, Teresa Gibson, Wendy Lynch, and Carol Addy, illustrates some surprising findings.

While the national norm is a one-size fits all approach, which is in most cases the CEO having the same health plan design as the janitor, this article shows that the health care utilization of the lowest paid members is on average quite different from that of the highest paid members. The total cost of care for both quartiles was relatively close and higher than the middle quartiles in a landmark study, but the nature of the medical care was quite different. The lowest income quartile used significantly less preventive care (much of which would be free under the ACA), three times as many Emergency Room visits, and four times as many avoidable hospital admissions. See the Abstract above for more details. This issue of looking at health plan utilization by income bracket is certainly not main stream but it should be, at least for employee demographics where there is a wide disparity between the lowest and highest paid members.

Note, while the employee incomes are fairly easy to track in most cases, there is usually no information on spousal income and the utilization of children must necessarily follow the income of the parent employee—even though dual incomes can throw that assumption into question.