Every two years, the Deloitte Health Institute runs an employee health survey in the UK. Our 2023 survey revealed that the gap in women respondent’s out of pocket expenditure on their healthcare, compared to mens, extrapolated to the working population, was £1.5 billion. The findings suggested that working women have more limited options in tackling their health needs and feel they have no option but to fund these needs from out-of-pocket spending.¹ This blog explores the differences in spending in 2023 of UK respondents from a white background and those from ethnic minority backgrounds. Overall, we found that employees in the UK from ethnic minority backgrounds spend 40 per cent more out-of-pocket than those from white backgrounds. The full results of our survey analysis can be found here.

We found that survey respondents employed in the UK who were from an ethnic minority background, spent on average, £101 a year more from out-of-pocket than those from a white background (£355 per year vs £254 per year respectively) – see Figure 1. If this additional spend was applied to the number of working people from an ethnic minority background in the UK (some 10.57 million people) the total additional out of pocket spend on health could be as much as additional £1.07 billion a year.

This additional out-of-pocket spend by employees from an ethnic minority background for both men and women varied between the different health categories:

• for medical diagnostics and wearables, 2.6x higher
• for general health care (e.g. dental, private GP, physio and pain), 1.3x higher
• for mental health support and private counselling, 1.2x higher
• for long covid treatment, 4.3x higher, but from a very low base
• fertility, menopause and menstrual health has no noticeable difference.

Gender disparities

When we looked at the survey responses on spending by gender there were some interesting differences (see Figure 2). While respondents spent most on the ‘general health care’ category, and least on ‘private long covid treatment’ category, men from ethnic minority backgrounds spent noticeably more on general healthcare than men from a white background and more than all women. Meanwhile, women from an ethnic background spent more on diagnostics, private counselling, long covid and women’s health problems than women from a white background.

A recent report by the King’s Fund found that women from ethnic minority groups experienced inequalities in health, and in access to, and experience of, health care services. Moreover, the King’s Fund research identified that “risks to health and health inequalities in women from ethnic minority groups started early and were apparent across the life course”. Their specific health needs were often not fully recognised or addressed by health care services’. Moreover, the findings were not homogenous with patterns of health, and the determinants of health, differing significantly between and within ethnic groups.²

Similarly, a report by the Royal College of Obstetricians and Gynaecologists found that three years on from the 2022 Women’s Health Strategy for England and its promise to reset the dial on women’s health; there had been some green shoots of progress, such as new investment in women’s health hubs and progress in research. However, almost 580,000 women were still waiting for gynaecology care in England with persistent inequalities across the system.³

These reports and other research into health inequalities together with our survey findings suggest that access to and use of NHS services could partly explain our survey findings with different healthcare needs and societal expectations also playing a role. However, it also suggests the need for a deeper analysis of ethnic differences in out-of-pocket spending.

Socio-economic status

When we looked at socio-economic status and out-of-pocket expenditure (see Figure 3) we found that people in a higher socio-economic group spent more overall; but those from an ethnic minority background spent the most (£474 vs £358) with the highest expenditure on general healthcare (again the reasons for this need further research albeit some of the difference could reflect their spend on their dependents, given the 50 per cent more spent on menopause and fertility etc.). They also spent almost double on diagnostics and wearables, and nine times more on long covid treatment (albeit from a small base).

Of the individuals in the lower socio-economic group, those from an ethnic minority background spent only slightly more out-of-pocket than those from a white background (£202 vs £192) but all much lower than those in the higher socio-economic group. While general healthcare is the highest category of spend for both groups; ethnic minority employees with a lower socio-economic status spent more on general healthcare, private long covid treatment, and women’s health issues, and less on counselling and medical diagnostics. This suggests when money is tight, out-of-pocket spending is directed more towards treatment than preventing future ill health. This spending pattern risks widening health inequalities in the future.

Availability of women’s health benefits on employment decisions

We looked at the extent to which the availability of women’s health benefits was a key factor in employment decisions of men and women from a white and ethnic minority background. Figure 4 shows that both men and women from an ethnic minority background are more likely to consider the availability of health benefits when making employment decisions and had greater awareness health benefits that were on offer. This could potentially reflect the fact that people from an ethnic minority background may be more reliant on healthcare support offered by their employer due to potential difficulties accessing public health services.

These data suggest there is a requirement for employers to consider the specific needs of diverse employee groups when designing and communicating benefits packages. However, a literature review of health and wellbeing interventions in the workplace and the extent to which the needs of ethnic minorities are considered in the design of benefits, show that while diversity, equality and inclusion (DE&I) are deemed important, there is very little research reporting the perceptions and attitudes of ethnic minorities, making it difficult to determine how best to do this. The review concluded that a client-centred approach using methods such as co-design were key to enabling interventions to be designed and adapted in a way that was culturally sensitive and inclusive for the whole workforce.⁴

Addressing ethnicity-based disparities in health requires a collaborative and multi-sectoral approach that involves action at the individual, community, institutional, and policy levels. By working together, stakeholders can help create a system that promotes equitable access to high-quality care for all individuals (see Figure 5).

Conclusion

Our analysis revealed wide disparities in out-of-pocket healthcare spending between ethnic minority and white employees in the UK, with ethnic minority employees spending considerably more across most categories, particularly on general healthcare. This suggests that neither the NHS nor current workplace benefits adequately meet their needs. These disparities are further amplified by socioeconomic status and gender, with women from ethnic minority and lower socio-economic backgrounds exhibiting spending patterns focused more on treatment than prevention, potentially exacerbating health inequalities. The identified gap in research highlights that employers, healthcare providers and insurers stakeholders would benefit from a more rigorous assessment of the issues raised.

__________________________________________________________________________