Health Savings Accounts (HSA's) and their accompanying High Deductible Health Plans have been touted as consumer-friendly and cost saving since their inception in 2003. But what is their impact on those who are inured with them, what has their experience been?
Now we have some evidence and reuslts from a first-ever study of HSA's by the rand Corporation. The largest-ever assessment of high-deductible health plans finds that while such plans significantly cut health spending, but the study also showed that HSA's also prompt patients to cut back on preventive health care, according to the RAND study. The findings are published in the March edition of the American Journal of Managed Care).
Studying more than 800,000 families from across the United States, the Rand researchers found that when people shifted into health insurance plans with deductibles of at least $1,000 per person, their health spending dropped an average of 14 percent when compared to families in health plans with lower deductibles.
Health care spending also was lower among families enrolled in high-deductible plans that had moderate health savings accounts sponsored by employers. But when employer contributions to such savings accounts accounted for more than half of an individual's deductible, savings decreased among families enrolled in these so-called consumer-directed health plans. The extra contibution by the employers therefore played a large part in the insured's additional use of health care.
However, over the same period, families that shifted to high-deductible plans significantly cut back on preventive health care such as childhood immunizations, cancer screenings and routine tests for diabetes.
"We discovered that costs go down dramatically during the first year people are enrolled in high-deductible health plans, as long as the deductible is at least $1,000 per person," said Amelia M. Haviland , a study co-author and a statistician at RAND, a nonprofit research organization. "But we also found concerning reductions in use of preventive care. This suggests people are cutting both necessary and unnecessary care."
Researchers examined the experiences of families insured during 2004 and 2005 through one of 53 large employers, with about half of the employers offering a high-deductible or consumer-directed health plan. Previous studies have tracked the impact of high deductibles, but the evidence has been limited to the experience of a few plans and employers.
High-deductible and consumer-directed health plans have been gaining favor as one way to help control health care costs. By 2009, about 20 percent of Americans with employer-sponsored health coverage were enrolled in such plans. A 2010 survey found that more than 54 percent of large employers offered at least one high-deductible health plan to their employees.
Health care reform is expected to further encourage enrollment in high-deductible health plans as such plans are expected to be a key offering in the insurance exchanges being set up in many states to help the uninsured find health coverage.
