• Benjamin Ukert, Stephen Esquivel-Pickett, Manish Oza, Andrea DeVries, and Gosia Sylwestrzak.
• Texas A&M University, 212 Adriance Lab Rd, College Station, TX 77843. Email: bukert@tamu.edu.
• Am J Manag Care. 2022 May 1; 28 (5): e170-e177.

ObjectivesTo examine how health care utilization and spending vary for low-income employees compared with high-income employees enrolled in an employer-sponsored high-deductible health plan (HDHP).Study DesignWe use commercial medical claims data and administrative human resource data from a large employer between 2014 and 2018. We link the administrative data, which include details on salary and other benefit choices, to each employee in each year with medical claims. Our variables of interest include medical spending and utilization outcomes grouped into different care settings.MethodsUsing multivariate regressions, we estimate the association between salary buckets and health care utilization and spending, controlling for demographic characteristics, comorbidities of employees, human resource health plan benefits, and geography.ResultsEmployees earning less than $75,000 show lower rates of utilization and spending on preventive measures, such as outpatient visits and prescription drugs, while having higher rates of utilization of preventable and avoidable emergency department visits and inpatient stays, resulting in lower overall health care spending among lower-salary employees.ConclusionsLow-salary employees enrolled in HDHPs have higher rates of acute care utilization and spending but lower rates of primary care spending compared with high-salary employees. Results suggest that HDHPs discourage routine physician-patient care among low-salary employees.

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