title: Effects of health savings account-eligible plans on utilization and expenditures.
abstract: OBJECTIVE
  To assess the impact of a health savings account (HSA)-eligible plan on utilization and expenditures in an employer-sponsored Midwestern health plan which offered a traditional plan from 2003 through 2004 that was fully replaced by an HSA-eligible plan in 2005 and 2006.
  
  
  METHODS
  Retrospective pre-post design with a control group.
  
  
  METHODS
  Medical and pharmacy claims of plan members younger than 65 years who were continuously enrolled throughout the 4-year study period were used to evaluate the impact of switching to the HSA-eligible plan. Expenditure and utilization measures were compared with those for a control group covered by employers in the same industry and geographic location, while controlling for patient characteristics.
  
  
  RESULTS
  The HSA-eligible plan was associated with significantly lower total expenditures (-17.4%), fewer and less costly office visits (-13.6% and -20.3%, respectively), fewer emergency department (ED) visits (-20.1%), lower pharmacy expenditures (-29.2%), lower expenses per drug (-27.9%), a reduced likelihood of mammograms (odds ratio [OR] = 0.55, P <.05) and Papanicolaou tests (OR = 0.66, P <.05), and a borderline significant reduction in routine physical exams (OR = 0.76, P <.10). The HSA-eligible plan also was associated with increased outpatient facility expenditures (5.1%, P <.05).
  
  
  CONCLUSIONS
  Employer-sponsored HSA-eligible plans appear to be associated with lower healthcare expenditures and/or utilization, particularly for office visits, ED visits, and pharmacy. However, they also may discourage preventive care, leading to increased long-term medical costs. Employers offering HSA-eligible plans should ensure that there are no financial barriers for preventive services.
authors.affiliation: Rural Health Resource Center, Iowa City, IA 52246, USA. mary.charlton@va.gov
authors.forename: Mary E
authors.initials: ME
authors.lastname: Charlton
authors.forename: Barcey T
authors.initials: BT
authors.lastname: Levy
authors.forename: Robin R
authors.initials: RR
authors.lastname: High
authors.forename: John E
authors.initials: JE
authors.lastname: Schneider
authors.forename: John M
authors.initials: JM
authors.lastname: Brooks
mesh_terms: D000328:Adult; D000367:Age Factors; D016536:Competitive Medical Plans / Q000191:economics* / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D020402:Medical Savings Accounts / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D011243:Preferred Provider Organizations / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D014481:United States