A two-employer, five-year study suggests that health account plans could lead to a long-term decrease in use of outpatient care and prescription drugs, mixed effects on use of hospital care, and a temporary drop in use of cancer screening services.
A team of researchers led by Paul Fronstin, an analyst at the Employee Benefit Research Institute (EBRI), has published the health account program data in an article in Health Affairs, a health finance and health policy academic journal.
Fronstin and his colleagues conducted the study by gathering data from two large employers for a period that started Jan. 1, 2006, and ended Dec. 31, 2010.
On Jan. 1, 2007, one of the employers replaced a traditional preferred provider organization (PPO) plan with a program that included a high-deductible plan and a health savings account (HSA). The HSA program option was the employer’s only health coverage option.
The second employer — the control group employer — continued to offer a traditional moderate-deductible PPO program.
The researchers tried to match the 13,278 active workers and dependents in the first employer’s HSA program with control-group plan enrollees with similar characteristics.
The researchers then adjusted for many different variables and looked at how plan enrollees at each employer compared from 2006 through 2010 in terms of measures such as inpatient hospital admissions, inpatient hospital days, emergency department visits, outpatient care use, prescription drug fills, and use of three recommended types of cancer screening.
The cancer screening measures used were breast cancer screening for women ages 40 and older; cervical cancer screening for women ages 21 and older; and colorectal cancer screening for people ages 50 and older.
The researchers found that the HSA program enrollees clearly used less outpatient care and fewer prescription drugs from the time they entered the health account program until the end of the study period.
In 2007, for example, the typical HSA program enrollee program had about 2.7 outpatient office or clinic visits, or about half a visit fewer than the typical control-group enrollee.
In 2010, the typical HSA program was still using about one-quarter fewer outpatient visits per year than the typical control-group enrollee.
Similarly, the typical HSA program enrollee filled about eight prescriptions in 2007, or 1.4 fewer prescriptions than researchers would have expected if the enrollee had still been in a traditional plan. In 2009 and 2010, the typical HSA program enrollee was still filling about one fewer prescription per year than a comparable traditional plan enrollee would have filled.