Is health status related to enrollment in high deductible health plans and tax-advantaged savings accounts?

摘要

High deductible health plans (HDHPs) and their associated saving vehicles have been growing in popularity since the Medicare Prescription Drug Improvement and Modernization Act of 2003 introduced Health Savings Accounts (HSAs) and a 2002 Internal Revenue Service ruling clarified the structure of Health Reimbursement Arrangements (HRAs). The incentive structures of HDHPs coupled with HSAs/HRAs differ starkly from traditional health insurance plans. Proponents of these plans claim that their unique structure induces more cost-effective consumption of health care services and therefore helps lower premiums. However, others claim that the incentives of such plans attract healthier individuals and, consequently, impact the cost of more traditional health insurance plans by making their risk pools sicker.;Using 2008 data from the National Health Interview Survey and logistic regression analyses, this paper investigates whether such plans disproportionately attract healthier individuals by analyzing whether individuals with certain health conditions are less likely to enroll in HDHPs and HSAs/HRAs than in traditional health insurance plans. The population studied in this analysis included adults ages 18 to 64 with private insurance.;The analysis yielded different results for individuals who obtained health insurance through their employer or union and those who purchased their insurance directly. No evidence of selection into HDHPs or HSAs/HRAs was found for individuals who purchased insurance through their employer or union. On the other hand, individuals who purchased HDHPs or HSAs/HRAs directly (e.g., in the individual insurance market) were slightly healthier compared to those who directly purchased more traditional insurance plans.;Because healthier individuals did not disproportionately enroll in HDHPs or HSAs/HRAs when the plan was purchased through their employer/union, this indicates that an employer's decision to offer such plans in addition to more traditional plans does not necessarily lead to sicker risk pools for the traditional plans. However, the finding that healthier individuals in the individual insurance market did tend to disproportionately enroll in HDHPs and HSAs/HRAs suggests that employer contributions to HSAs/HRAs might be a factor in stopping differential selection.