Socioeconomic disparities in access to care and healthcare expenditures among U.S. adults: evidence from the Medical Expenditure Panel Survey, 2018-2022.

BACKGROUND

Socioeconomic disparities in health insurance coverage, income, and education are well-established determinants of healthcare access and spending in the United States. Less is known about how these disparities manifested during 2018-2022, a period marked by major disruptions to healthcare delivery during the COVID-19 pandemic. This study examined associations of insurance coverage and poverty level with access to care and of educational attainment with healthcare expenditures among U.S. adults.

MATERIALS AND

METHODS

Medical Expenditure Panel Survey (MEPS) Full-Year Consolidated files from 2018 to 2022 were pooled and analyzed. Survey-weighted logistic regression models were estimated for access-to-care outcomes, adjusting for age, sex, race/ethnicity, and calendar year, while accounting for MEPS's complex survey design. Given the skewed distribution of expenditures, two-part models were used, combining logistic regression for any spending with gamma generalized linear models for expenditures among spenders.

RESULTS

Among adults under age 65, uninsured individuals had higher odds of delayed medical care and substantially lower odds of having a usual source of care compared with privately insured adults. Lower poverty levels were associated with progressively worse access outcomes. Educational attainment was strongly related to healthcare spending: adults with lower education were less likely to incur any expenditures, but among spenders, total costs were modestly higher and out-of-pocket spending consistently lower than among adults with a bachelor's degree or higher.

CONCLUSION

Socioeconomic disparities in healthcare access and expenditures persisted during 2018-2022, underscoring the need for policies that expand coverage, strengthen primary care access, and reduce cost-related barriers for disadvantaged populations.