Mixed bag for HSAs: Reduced outpatient costs, higher inpatient use

A new report from the Employee Benefit Research Institute (EBRI) shows that the use of Health Spending Accounts (HSAs) helps reduce the use of outpatient services; prescription drugs and increased use of inpatient services for HSA-eligible plan enrollees.

“The purpose of our research was to closely examine the impact of plan type on the use of health care services and spending. The analysis focused on enrollees in HSA plans and preferred provider organization (PPO) enrollees who are in health plans with deductibles large enough to be HSA eligible as a way of isolating the impact of the HSA on use of health care services,” explained Paul Fronstin, Ph.D., director, Health Benefits Research, EBRI.

Key findings in the new research report, “HSAs Reduce Use of Outpatient Services and Prescription Drugs, Increase Use of Inpatient Services; Overall Spending Unaffected,” include:

• HSA plans have mixed effects on the use of health care services. Inpatient admissions and days were higher in HSA plans than in PPOs. The additional inpatient admissions do not appear to be coming from emergency department visits, as HSA plan enrollees used emergency departments less than PPO enrollees.
• Office visits shifted from specialist visits to primary care visits among HSA plan enrollees.
• HSA plan enrollees filled fewer prescriptions as compared with PPO enrollees.
• When it comes to health conditions, there were vast differences in changes in use of health care services by plan type between those with no health conditions and those with two or more. Among individuals with no health conditions, HSA plans resulted in fewer emergency department visits relative to PPO enrollees, fewer specialist visits and fewer prescription drug fills, while visits to primary care providers increased.
• In contrast, among enrollees with two or more health conditions, there were no instances of decline in health care services among those in HSA plans relative to PPO enrollees. Instead, those with two or more health conditions experienced increases in inpatient admissions, inpatient days and primary care office visits.

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“The research concluded that HSA plans have mixed effects on use of health care services. Inpatient admissions and days were higher in HSA plans than in PPOs. The additional inpatient admissions do not appear to be coming from emergency department visits, as HSA plans enrollees used emergency departments less than PPO enrollees,” said Fronstin.

“Interestingly, there is a shift from specialist visits to primary care visits among HSA plans enrollees. The HSA plan enrollees also filled fewer prescriptions as compared with PPO enrollees. Overall, HSA plan enrollment had no impact on total spending and there was no statistically significant difference in overall spending between HSA plan and PPO enrollees.”