Study: Health Savings Accounts Aren’t Working

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They're leading to more emergency room visits, fewer screenings for cancer and fewer prescriptions.

Consumer-directed health plans such as health savings accounts are resulting in fewer physician visits and prescriptions, and more trips to the hospital, new research says.

They’re supposed to encourage the opposite — more preventive care — by burdening employees with a high deductible, an Employee Benefit Research Institute study says.

EBRI compared employees at two companies, one of which had an HSA for all of its employees for four years, and one which had a more traditional kind of plan. Between the two companies there were nearly 24,000 employees. For the company with the HSA plan, it found:

There were 0.26 fewer physician office visits per enrollee per year and 0.85 fewer prescriptions filled, although there were 0.018 more emergency department visits (all of which are considered statistically significant). Additionally, the likelihood of receiving recommended cancer screenings was lower under the HSA plan after one year and, even after recovering somewhat in later years, still lower than baseline at the study’s  conclusion.

EBRI notes that more employers have been adopting such plans in lieu of traditional ones because they are cheaper, and more are likely to as the Affordable Care Act fully kicks in next year. EBRI says if employers are going to take the cheaper route, they should do a better job of educating employees and also incentivize preventive care.

“Given these findings, employers should consider providing periodic, ongoing communications to enrollees regarding services that are exempted from the deductible,” study co-author Martín J. Sepúlveda says.

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