High-Deductible Health Plans for US Children: Trends, Health Service Use, and Financial Barriers to Care

ABSTRACT Objective Few studies have examined children's enrollment in high-deductible health plans (HDHPs) and associations with health service use. We examine trends, health service use, and financial barriers to care for US children with high-deductible private insurance. Methods Trend data on HDHP enrollment was available for 58,910 children ages 0-17 with private insurance from the 2007-2018 National Health Interview Survey. Health service indicators were examined in a cross-sectional sample of 23,959 children in the 2014-2018 datasets. High deductible was defined as a minimum of $2,700 for a family in 2018. Chi-square tests examined associations of HDHPs with health service indicators. Logistic regression models adjusted for sociodemographics and child health. Results The percent of privately insured children with HDHPs increased from 18.4% to 48.6% from 2007-2018. In adjusted regression, those with HDHPs fared worse than those with traditional plans on 7 of 10 measures and those with HDHPs and no health savings account (HSA) fared worse on eight. While small differences were found for various child-focused measures, the most consistent differences were found for family-focused measures. Parents with HDHPs were more likely than parents with traditional private insurance to report they had delayed or forgone their medical care (10.2% vs. 5.7%), had problems paying medical bills (15.7% vs. 10.3%), and had family medical debt (34.1% vs. 25.8%). Conclusions Privately insured families have seen substantial growth in high-deductible plans in the last decade. Families with HDHPs, especially those without HSAs, have more financial barriers to care.