Address correspondence to Anthony T. Lo Sasso, Ph.D., Professor, Division of Health Policy and Administration, School of Public Health, University of Illinois, 1603 W. Taylor Street, Chicago, IL 60612; e-mail: email@example.com. Mona Shah, M.S., Senior Product Research Consultant, is with UnitedHealthCare Group, Edina, MN. Bianca K. Frogner, Ph.D., Assistant Professor, is with the Health Services Management and Leadership Department, School of Public Health and Heatlh Services, The George Washington University, Washington, DC.
Health Savings Accounts and Health Care Spending
Version of Record online: 28 MAY 2010
© Health Research and Educational Trust
Health Services Research
Volume 45, Issue 4, pages 1041–1060, August 2010
How to Cite
Lo Sasso, A. T., Shah, M. and Frogner, B. K. (2010), Health Savings Accounts and Health Care Spending. Health Services Research, 45: 1041–1060. doi: 10.1111/j.1475-6773.2010.01124.x
- Issue online: 8 JUL 2010
- Version of Record online: 28 MAY 2010
- Consumer-driven health plans;
- high deductible health insurance;
- health savings accounts;
- benefit design
Objective. The impact of consumer-driven health plans (CDHPs) has primarily been studied in a small number of large, self-insured employers, but this work may not generalize to the wide array of firms that make up the overall economy. The goal of our research is to examine effects of health savings accounts (HSAs) on total, medical, and pharmacy spending for a large number of small and midsized firms.
Data Sources. Health plan administrative data from a national insurer were used to measure spending for 76,310 enrollees over 3 years in 709 employers. All employers began offering a HSA-eligible plan either on a full-replacement basis or alongside traditional plans in 2006 and 2007 after previously offering only traditional plans in 2005.
Study Design. We employ difference-in-differences generalized linear regression models to examine the impact of switching to HSAs.
Data Extraction Methods. Claims data were aggregated to enrollee-years.
Principal Findings. For total spending, HSA enrollees spent roughly 5–7 percent less than non-HSA enrollees. For pharmacy spending, HSA enrollees spent 6–9 percent less than traditional plan enrollees. More of the spending decrease was observed in the first year of enrollment.
Conclusions. Our findings are consistent with the notion that CDHP benefit designs affect decisions that are at the discretion of the consumer, such as whether to fill or refill a prescription, but have less effect on care decisions that are more at the discretion of the provider.