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Effects of Health Savings Account Eligible Plans on Utilization and Expenditures
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Effects of Health Savings Account Eligible Plans on Utilization and Expenditures

Mary E. Charlton, PhD; Barcey T. Levy, PhD, MD; Robin R. High, MBA, MA; John E. Schneider, PhD; and John M. Brooks, PhD

The health savings account-eligible design may decrease costs and utilization, but it also may decrease use of preventive services.

While the Internal Revenue Service allows deductibles to be waived for selected preventive services, it mandates that any service or benefit intended to treat an existing illness, injury, or condition must be subject to the deductible, so first dollar coverage of monitoring services such as glycosylated hemoglobin tests for people with diabetes is not currently allowed. Our study did not have adequate numbers of members with chronic conditions such as diabetes and hypertension to evaluate the impact of the HSA-eligible plan on the healthcare patterns of those populations, but showed that use of some preventive services decreased after the switch to the HSA-eligible plan design. This finding calls into  question whether people with chronic conditions would continue to use monitoring services intended to prevent complications and/or worsening of disease after switching to an HSA-eligible plan design. Results of this study support the notion of a “value based insurance design waiver” for HSA-eligible plans to allow for first dollar coverage of highly valued services.22

Author Affiliations: From Rural Health Resource Center (MEC), Iowa City Veterans Affairs Medical Center, Iowa City, IA; Department of Health Management & Policy (MEC), Department of Epidemiology (MEC), Department of Pharmacy Practice and Science (JMB), Department of Family Medicine (BTL), University of Iowa, Iowa City, IA; Department of Biostatistics (RRH), University of Nebraska Medical Center, Omaha, NE; and Oxford Outcomes, Inc (JES), Morristown, NJ.

 

Funding Source: The authors report no external funding for this research.

 

Author Disclosures: The authors (MEC, BTL, RRH, JES, JMB) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

 

Authorship Information: Concept and design (MEC, BTL, JES, JMB); acquisition of data (MEC); analysis and interpretation of data (MEC, BTL, RRH, JES, JMB); drafting of the manuscript (MEC, RRH, JES); critical revision of the manuscript for important intellectual content (MEC, BTL, JES, JMB); statistical analysis (MEC, RRH, JES, JMB); provision of study materials or patients (MEC); obtaining funding (MEC); administrative, technical, or logistic support (JES); and supervision (JES).

 

Address correspondence to: Mary E. Charlton, PhD, Rural Health Resource Center, Iowa City Veterans Administration Medical Center, 601 Hwy W, Iowa City, IA 52246. E-mail: mary.charlton@va.gov.

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20. Varghese RK, Frieman C, Ahmed F, Franks AL, Manning M, Seeff LC. Does health insurance coverage of office visits influence colorectal cancer testing? Cancer Epidemiol Biomarkers Prev. 2005;14(3):744-747.

 

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22. Fendrick AM, Chernew ME. Value-based insurance design: a clinically sensitive, fiscally responsible approach to mitigate the adverse clinical effects of high-deductible consumer-directed health plans. J Gen Intern Med. 2007;22(6):890-891.

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