New IBI Study Finds That 1 in 3 Lower-income Workers Do Without Needed Care They Cannot Afford—Which Can Increase their Sick Days By Nearly 70%

OAKLAND – July 24, 2019 – One in three lower-income employees experienced a need for health care they could not afford according to a new study from the Integrated Benefits Institute (IBI), a nonprofit health and productivity research organization. On average, employees who experienced a cost-related barrier to care had 70% more sick days than their peers who experienced no barriers to care.

The analysis examined nationally representative data collected by the Centers for Disease Control and Prevention between 2007 and 2017. Focusing on employees with annual family incomes below $35,000, the study authors found that one in three lower-income workers experienced a cost-related barrier to care in the 12 months prior to the survey. More than half of uninsured employees experienced a cost-related barrier to care, compared to about one-fifth of insured employees.

Enrollees in a high-deductible health plan ($1,100 or higher for a single plan, $2,200 or higher for a family plan) were 75% more likely than low-deductible enrollees to experience a cost-related barrier to care. Health savings accounts did not reduce the risk of experiencing cost-related barriers for employees with high deductibles. However, flexible spending accounts and coverage for prescription medications were associated with reduced risk of experiencing cost-related barriers to care.

The study further found that on average, employees with any cost-related barrier had almost five sick days absences per year compared to less than three days per year for employees who experienced no barrier to care.

“We were not surprised that a lot of people put off or did without medical care because they just couldn’t afford it,” said Brian Gifford, PhD, IBI’s Research Director and the study’s lead author. “More and more studies show that even people who have jobs with health benefits cut back on necessary health care services due to the out-of-pocket costs of high deductibles, copayments, and coinsurance. The finding that unaffordable care was associated with almost two additional full days of absence, even after considering health status age, sex, and race, really drives home the point that productivity losses are eating away some of employers’ savings from increased cost sharing.”

While the study focused primarily on lower income workers, additional analyses found that while fewer employees with annual family incomes above $35,000 faced cost-related barriers to care, delaying or foregoing needed care took a similar toll on absences.

Thomas Parry, PhD, IBI President, commented on the findings, “This research underscores the importance of aligning incentives between employees and their health, and employers and their businesses. Creating obstacles to good employee health serves no one’s interests and only creates sicker employees that cannot show up and perform their jobs. A bad bargain for everyone.”

Additional study findings:

• One in three lower-income employees experienced a cost-related barrier to care over the course of 12 months. Nearly one in four delayed needed care, compared to about one in five who could not afford medical care, and almost one in six who could not afford prescription medications. Only about one in 20 reported that they needed but could not afford mental health care.
• More than half of uninsured lower-income employees experienced a cost-related barrier to care, compared to about one-fifth of insured lower-income employees.
• If only one in five lower-income employees had experienced a cost-related barrier to care— roughly the rate experienced by employees with low deductible insurance—there would have been 6% fewer lost workdays among this population. Lost workdays would have been 8% less if the overall rate of barriers was as low as that experienced by employees with low deductible insurance, coverage for prescriptions, and a flexible spending account (about 18% of whom experienced a barrier to care).
• While employees with incomes above $35,000 experienced fewer barriers to care, the association with health insurance and plan design was stronger than was observed at lower income levels. But barriers to care had a similar impact on lost workdays across the income distribution.

IBI/Conference Board Health and Productivity Forum

To help employers maximize the value of workforce health and productivity, the new 2019 IBI/Conference Board Health and Productivity Forum will be held Sept. 18-20, 2019 at the Swissotel Chicago. Learn more and register here.

About Integrated Benefits Institute

The Integrated Benefit Institute’s independent research, industry-leading tools and data resources help companies link health-related programs to the outcomes that maximize the contributions of people to productivity and business performance. Founded in 1995, IBI is a national nonprofit research organization and business association serving 1,100 employer and supplier members and their 22 million employees. . For additional information, please visit www.ibiweb.org and follow us on Twitter and LinkedIn.

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