Hearing Witnesses Critique HSA Approach

The other witnesses, including representatives from the U.S. Government Accountability Office and the Urban Institute, Washington, said the tax breaks offered to encourage use of HSAs appear to go mainly to help higher income taxpayers and do not appear to do much to increase access to health coverage.

Another witness, Michael Chernew, a health care policy expert at the Harvard University medical school, said consumers rarely have access to enough relevant information to make good health care purchasing decisions.

One think tank study has shown that, when cost-sharing increased, “patients reduced utilization of services deemed clinically appropriate by the same amount as they reduced the use of services deemed clinically inappropriate,” Chernew testified.

Doubling the co-payment for medication to $20, to $10, decreased use of blood pressure drugs by 10% and use of anti-diabetes drugs by 23%, Chernew said.

Chernew did not discuss efforts by HSA and HRA program managers to encourage use of preventive care by offering “first dollar” coverage for routine diabetes care, routine hypertension care and other preventive care.

Chernew noted that he and colleagues are preparing to publish a study that will show how increases in patient cost sharing affect HEDIS health care quality indicators.