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

Abstract

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.