EBRI Examines HSAs’ Effect On Healthcare Choices

The high-deductible health plans (HDHPs)associated with health savings accounts (HSAs) may be leading lower-income employees to avoid certain healthcare services, the Employee Benefit Research Institute (EBRI) warned.

Examining the claims of one large Midwestern employer, EBRI found major variations by income level in the use of some health services. For example, while switching to an HDHP led employees at all income levels to make fewer outpatient office visits, the decline was twice as great for workers making less than $50,000 per year (and their dependents) as for those making at least $100,000.

EBRI also found a link between HDHPs and the reduced use of preventive services, such as flu vaccines, by lower-income employees. Meanwhile, these individuals’ rate of emergency room visits and inpatient hospital admissions increased, although these appeared to be short-term effects.

However, other types of healthcare services appeared to be unaffected by either HSA/HDHP adoption or worker income, according to EBRI’s study. These included inpatient hospital days, avoidable emergency department visits, pneumonia and HPV vaccinations, and blood sugar testing for diabetics.

“A key question with high-deductible HSA-eligible health plans is how the income differences of workers affect the use of health care services and spending: Do lower-paid workers defer health care more than higher-paid workers?” explained coauthor Paul Fronstin, director of EBRI’s Health Research and Education Program, in announcing the report. “We found mixed results: For some health services, yes it does—but for others, it does not.”

The large employer that was the subject of the study offered an HSA-eligible HDHP alongside a PPO. The data included between 150,000 and 200,000 individuals, and covered their healthcare services and spending over a 6-year period, from 2009 through 2014.

The apparent short-term nature of the spike in emergency and inpatient admissions may alleviate some of the underlying concerns, the report concluded. “However, if sponsors or insurers are concerned about the impact of HSA-eligible health plans on lower-income workers, they can consider modifications” such as higher HSA contributions for lower-income employees and education about the preventive services not subject to the deductible.