Health Savings Plans and Disparities in Access to Care by Race and Ethnicity.

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.