When Workers Contribute, They're More Likely to Skip or Delay Care, Reports Study in Medical Care
Newswise — Philadelphia, Pa. (August 7, 2012) – Workers who make employee contributions to their health savings accounts (HSAs)—as opposed to those with employer contributions only—are more likely to be cost-sensitive in making health care decisions, according to a study in Medical Care. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
"We found that consumers in consumer-directed health plans often report changing their care-seeking behavior in response to costs," according to the new research, led by Mary Reed, DrPH, of the Kaiser Permanent Medical Care Program, Oakland, Calif. "Importantly, we found that the source of HSA contributions significantly impacts the frequency of these responses."
When Employees Contribute to HSAs, Care-Seeking Is More Likely AffectedThe researchers looked at how the source of HSA contributions affected medical care decisions among 488 employees eligible for employer-sponsored HSA plans. Often coupled with high-deductible insurance plans, HSAs let employees save tax-free dollars for use in meeting deductibles and paying other health-related costs not covered by insurance.
Most employees made personal contributions to their HSAs: 32 percent received employer contributions and also made their own employee contribution, and 19 percent only made their own employee contribution. Thirty-five percent only received employer contributions.
The remaining 14 percent had no HSA contributions from either source, and thus presumably paid their deductible out-of-pocket. For more than half of employees, total HSA contributions were less than their insurance plan's deductible amount.
After adjustment for other factors, those who made employee contributions in addition to employer contributions were more likely to report that costs affected their healthcare-seeking behavior. For example, 39 percent with employee contributions said they skipped or delayed emergency department (ED) visits because of costs, compared to 31 percent of those with employer contributions only. Routine office visits were affected as well: 60 versus 49 percent, respectively.
Having 'Skin in the Game' Increases ImpactEmployees who made their own HSA contributions (or paid out-of-pocket) were more likely to say they were under financial burdens, compared to those with employer-only contributions. Older employees and those with higher incomes were more likely to make HSA contributions—possibly because they were attracted to the HSA as a way of reducing pre-tax income.
Health savings accounts are one way of encouraging employees to be cost-sensitive in their use of health care services. The new study is one of the first to look at whether and how the source of HSA contributions determines the effect on health care use.
The results suggest that most eligible employees make personal contributions to their HSA. Those who make personal contributions are more likely to alter their care-seeking behavior, suggesting that employees perceive their own versus their employer's contributions differently. Making personal contributions to an HSA may make employees feel like they have more "skin in the game," Dr Reed and coauthors suggest.
Although the study didn't look at whether the changes in healthcare-seeking behavior were medically appropriate, the findings raise some concerns. Delaying or avoiding ED visits may have "real potential for adverse consequences." The fact that some employees avoided routine office visits was surprising, because preventive care is exempt from the insurance deductible. That raises questions about how well employees understand the details of their plans.
"Overall, the amount of 'skin' that a patient 'has in the game' may depend on whether their employer is already making a substantial HSA contribution to offset their deductible," Dr Reed and colleagues conclude. Noting that enrollment in HSA-eligible health plans is likely to increase in future years, they add, "Much of this growth in high-deductible plan enrollment will likely lack employer contributions to the savings account."
About Medical CareRated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care. Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services. In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume. Medical Care is the official journal of the Medical Care Section of the American Public Health Association
About Lippincott Williams & Wilkins Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).
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