The Impact of an HSA-Eligible Health Plan on Health Care Services Use and Spending by Worker Income

Summary

This study examines whether there is variation by worker income on how an HSA-eligible health plan affects health care services use and spending. Does the typically flat-dollar gap between a health plan’s deductible and the employer contribution to a health savings account (HSA) have a bigger impact on the use of health care services among lower-income workers than it does for higher-income workers?

The data for this study come from a large employer that offered an HSA-eligible health plan alongside a preferred provider organization (PPO), includes between 150,000 and 200,000 individuals, and covers health care services use and spending over the six-year period from 2009-2014.

Here are the key findings:

• The HSA-eligible health plan was associated with a decline in (non-preventive) outpatient office visits for workers at all income levels, but the decline was over twice as large for workers and their dependents with incomes less than $50,000 as compared with those with incomes of at least $100,000. The decline in specialist visits accounted for most of the decline in outpatient office visits among the group of workers with less than $50,000 in income.
• There was an across-the-board decline in prescription drug fills regardless of worker income. However, unlike the results for outpatient physician office visits, there was not a clear relationship with income level.
• The HSA-eligible health plan was associated with a reduction in various preventive services by worker income. For example, lower-income workers reduced their use of influenza vaccinations more than higher-income workers. The usage of preventive office visits exhibited the same general pattern as influenza vaccinations.
• In contrast to the other findings, the HSA-eligible health plan was associated with an increase in emergency department visits and inpatient hospital admissions among lower-income individuals.
• The usage levels of certain health care services--inpatient hospital days, avoidable emergency department visits, pneumonia vaccinations, human papillomavirus (HPV) vaccinations, and glycated hemoglobin (HbA1c) testing for individuals with diabetes--were unaffected by enrollment in the HSA-eligible health plan both overall and by worker income.