EBRI Issue Brief

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

Aug 30, 2016 24  pages


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.