Healthcare spending has grown faster among higher-income Americans than lower-income Americans over the past two decades.
The largest differences were seen in outpatient care and prescription drug spending.
Researchers say the widening gap may reflect growing differences in healthcare access and use.
Americans are spending more on healthcare than they did two decades ago, but new research suggests that increase hasn't been shared equally.
According to a study published in Health Affairs, healthcare spending has risen much faster among people with higher incomes than those with lower incomes, creating a widening gap in how medical care is used.
The researchers note that overall healthcare spending growth has slowed since the early 2000s. Even so, when they looked more closely at spending by income level, they found that higher-income Americans accounted for a growing share of healthcare expenditures over time. The trend was especially noticeable for outpatient services and prescription medications.
Rather than suggesting that healthcare has become less important for lower-income households, the findings raise questions about whether people across different income levels are experiencing the same access to healthcare services.
How the researchers studied healthcare spending
To understand how healthcare spending has changed over time, researchers analyzed national healthcare expenditure data spanning roughly two decades, following trends through 2023. They compared spending patterns across income groups instead of looking only at total U.S. healthcare spending.
The analysis examined several categories of healthcare spending, allowing the researchers to see where differences between higher- and lower-income Americans were becoming most pronounced. Particular attention was given to outpatient medical care and prescription drugs, where spending diverged the most over the study period.
By tracking these long-term patterns, the researchers were able to identify changes that might not be obvious when looking only at national healthcare spending totals.
What the findings could mean for consumers
The study found that the gap in healthcare spending between high- and low-income Americans continued to widen through 2023. Higher-income households increased their spending at a faster pace, particularly on outpatient care and medications, while spending among lower-income households grew more slowly.
The researchers say these differences could indicate growing disparities in how people access and use healthcare services.
“If people are increasingly unable to access care, you end up with a healthcare system that only serves higher-income individuals,” researcher Betsy Q. Cliff, Ph.D. said in a news release. “That is the worry, and it’s something we need more research to understand.”
For consumers, the findings highlight that changes in healthcare spending don't necessarily affect everyone the same way. As healthcare costs and utilization continue to evolve, understanding how those changes vary by income may provide a clearer picture of who is receiving care — and who may face barriers to accessing it.