The Effects of HSAs

High-deductible health plans have grown rapidly in popularity with employers, if not with employees.  They are often accompanied by health savings accounts, which allow the employee to set aside money, often matched by the employer, to help pay for the higher out-of-pocket costs in an HDHP.  A new piece of research examines the effects of HSA related plans on utilization and spending.  (AJMC Article) Previous research has shown that individuals with this form of coverage are more likely to seek information about treatment alternatives and to choose the less expensive one.

This study compared employees with HDHP/HSA coverage with those who retained a traditional health plan over a four-year period.  In general, expenses for the traditional population increased faster than for the HDHP group, and median spending from the HDHP group was actually lower in the last year of the study than in the first.  Inpatient spending did not differ significantly between the groups, but total spending was 17% less, physician visit spending 20% less, pharmacy 29% less (and per prescription spending was 28% lower, indicating greater use of generics), but outpatient spending was higher for the HDHP/HSA  group.

At the same time, there was less use of mammograms and Pap smears in this population, indicating some avoidance of preventive tests.  Because the reform law basically forbids copays on preventive services, this should be less of an issue in the future.  The study did not look at actual health outcomes, so it is unclear how necessary any missed preventive services were.  It is clear that the plan saved money compared to traditional coverage, but again, without health outcomes, we don’t know if the lower spending affected health.