Use of Health Savings Accounts Among US Adults Enrolled in High-Deductible Health Plans.

Importance: Health savings accounts (HSAs) can be used by enrollees in high-deductible health plans (HDHPs) to save for health care expenses before taxes. Expansion of and encouraging contributions to HSAs have been centerpieces of recent federal legislation. Little is known about how US residents who may be eligible for HSAs are using them to save for health care. Objective: To determine which patients who may be eligible for an HSA do not have one and what decisions patients with HSAs make about contributing to them. Design, Setting, and Participants: This cross-sectional national survey assessed an online survey panel representative of the US adult population. Adults aged 18 to 64 years and enrolled in an HDHP for at least 12 months were eligible to participate. Data were collected from August 26 to September 19, 2016, and analyzed from November 1, 2019, to April 30, 2020. Main Outcomes and Measures: Prevalence of not having an HSA or not making HSA contributions in the last 12 months and reasons for not making the HSA contributions. Results: Based on data from 1637 individuals (American Association of Public Opinion Research response rate 4, 54.8%), half (50.6% [95% CI, 47.7%-53.6%]) of US adults in HDHPs were female, and most were aged 36 to 51 (35.7% [95% CI, 32.8%-38.6%]) or 52 to 64 (36.8% [95% CI, 34.1%-39.5%]) years. Approximately 1 in 3 (32.5% [95% CI, 29.8%-35.3%]) did not have an HSA. Those who obtained their health insurance through an exchange were more likely to lack an HSA (70.3% [95% CI, 61.9%-78.6%]) than those who worked for an employer that offered only 1 health insurance plan (36.5% [95% CI, 30.9%-42.1%]; P < .001). More than half of individuals with an HSA (55.0% [95% CI, 51.1%-58.8%]) had not contributed money into it in the last 12 months. Among HDHP enrollees with an HSA, those with at least a master's degree (46.1% [95% CI, 38.3%-53.9%]; P = .02) or a high level of health insurance literacy (47.3% [95% CI, 40.7%-54.0%]; P = .03) were less likely to have made no HAS contributions. Common reasons for not contributing to an HSA included not considering it (36.8% [95% CI, 30.8%-42.8%]) and being unable to afford saving for health care (31.9% [95% CI, 26.2%-37.6%]). Conclusions and Relevance: These findings suggest that many US adults enrolled in an HDHP lack an HSA, and few with an HSA saved for health care in the last year. Targeted interventions should be explored by employers, health plans, and health systems to encourage HSA uptake and contributions among individuals who could benefit from their use.

High-deductible Health Plan Enrollment Among Adults Aged 18-64 With Employment-based Insurance Coverage.

High-deductible health plans (HDHPs) are health insurance policies with higher deductibles than traditional insurance plans. Individuals with HDHPs pay lower monthly insurance premiums but pay more out of pocket for medical expenses until their deductible is met. An HDHP may be used with or without a health savings account (HSA). An HSA allows pretax income to be saved to help pay for the higher costs associated with an HDHP (1). This report examines enrollment among adults aged 18-64 with employmentbased private health insurance coverage by plan type and demographic characteristics. Approximately 60% of adults aged 18-64 have employmentbased coverage (2). All estimates in this report are based on data from the National Health Interview Survey (NHIS).

Austeridad y privatización sanitaria en época de crisis: ¿existen diferencias entre las comunidades autónomas? / Austerity and healthcare privatization in times of crisis: are there any differences among autonomous communities?

Objetivo: Analizar las diferencias entre comunidades autónomas según sus políticas de austeridad y privatización durante la crisis. Métodos: Se analizó el cambio producido en las comunidades autónomas en tres dimensiones: la aplicación de reformas legales, la privatización sanitaria y la financiación y los recursos sanitarios, y se construyó un indicador resumen por dimensión que se representó en mapas. Resultados: El País Vasco mostró el comportamiento más claro hacia una escasa política de austeridad y privatización, al contrario que La Rioja, Madrid e lslas Baleares durante la crisis. Conclusiones: Las categorizaciones permitirán analizar el efecto mediador de la diferente intensidad de las políticas de austeridad y privatización en la relación entre la crisis y la salud en el contexto español (AU)

Objective: To analyse the differences between autonomous communities in Spain according to their policies of austerity and healthcare privatization during the economic crisis. Methods: Changes in the application of legal reforms, healthcare privatization and healthcare financing/resources in the autonomous communities were analysed, and a summary indicator of each dimension was constructed. Results: The Basque Country showed the clearest behaviour towards a weak policy of austerity and privatization, as opposed to La Rioja, Madrid, and the Balearic Islands. Conclusions: The three classifications will enable analysis of the mediating effect of policies of austerity and privatization in the relationship between the economic crisis and health in the Spanish context (AU)

Health Savings Accounts: An Emerging Cornerstone of the Health-Wealth Bridge?.

Several trends may help make health savings accounts (HSAs) a ubiquitous part of Americans' financial planning. When one looks at the totality of factors, it is easy to see how HSAs can become a vital connection be- tween active and retiree health care needs and between retirement income and retiree medical needs. However, it is also easy to see the clouds over the horizon that could stall HSA growth in coming years. This article discusses both.

Valoración de la implementación de programa de ahorro de sangre en cirugía ortopédica / Assessment of the introduction of a blood management program in orthopaedic surgery

Objetivo. Describir el impacto de la introducción de un programa de ahorro de sangre (PAS) en las transfusiones, estancias hospitalarias y complicaciones debidas a la artroplastia total de cadera (ATC) y artroplastia total de rodilla (ATR). Material y métodos. Estudio observacional retrospectivo en el Hospital Universitario Araba, de 2006 a 2011. Se recogieron todas las ATR y ATC. La variable principal fue el porcentaje de pacientes transfundidos con sangre alogénica. Como variables secundarias se recogió la media de bolsas transfundidas, transfusiones totales (alogénica y/o autóloga), las complicaciones (totales y específicas), la edad y el sexo de los pacientes, hemoglobina prequirúrgica y al alta y la estancia hospitalaria. Resultados. Se incluyeron un total un total de 825 ATC y 875 ATR. Tanto en ATC (47,6% en 2006 y 30,6% en 2011; p = 0,013) como ATR (33,6% en 2006 y 16,2% en 2011; p < 0,001) se produjo una disminución significativa en las transfusiones alogénicas. Las transfusiones totales también disminuyeron en ATC (65,7% en 2006 y 39,5% en 2011; p < 0,001) y ATR (38,3% en 2006 y 17,2% en 2011; p < 0,001). La estancia disminuyó en ambas cirugías (p = 0,038 en ATC y p < 0,0001 en ATR). En 2006 fue de 9,2 ± 2,9 días en ATC y 11,1 ± 4,7 días en ATR, mientras que en 2011 fue de 8,7 ± 4,2 y 9,5 ± 3,4 días para ATC y ATR respectivamente. Conclusiones. La implementación del PAS, y sus aportaciones consecutivas, ha reducido significativamente el porcentaje de pacientes que requieren transfusiones, tanto alogénicas como autólogas. La estancia media disminuyó aunque no pueda establecerse el impacto del PAS en las mismas (AU)

Objective. To assess the impact of implementing a Patient Blood management program (PBM) on transfusion rates, hospital stay, and complications for total hip arthroplasty (THA) and total knee arthroplasty (TKA). Material and methods. A retrospective, observational study was conducted in Araba University Hospital from 2006 to 2011. All THA and TKA were included. The percentage of patients transfused with allogeneic blood was the primary endpoint. The mean of transfused blood bags, overall transfusion, complications (both overall and specific), patient age and sex, pre-operative and discharge hemoglobin, and hospital stay were recorded. Results. A total of 825 THA and 875 TKA were included. Both THA (47.6% in 2006 and 30.6% in 2011; P = .013) and TKA (33.6% in 2006 and 16.2% in 2011; P < .001) showed a significant decrease of allogeneic transfusion. The overall transfusion rate was also reduced in THA (65.7% in 2006 and 39.5% in 2011; P < .001) and TKA (38.3% in 2006 and 17.2% in 2011; P < .001). Hospital stay was reduced in both types of surgeries (P < .038 in THA and P < .0001 in TKA). In 2006 it was 9.2 ± 2.9 days for THA and 11.1 ± 4.7 days for TKA, whereas in 2011 it was 8.7 ± 4.2 and 9.5 ± 3.4 days for THA and TKA, respectively. Conclusions. Our patient blood management has decreased the percentage of patients that need both allogeneic and autologous transfusion in a statistically significant way. Although the mean hospital stay decreased, the impact of the PBM cannot be established (AU)

Health Savings Account Balances, Contributions, Distributions, and Other Vital Statistics, 2014: Estimates from the EBRI HSA Database.

The Employee Benefit Research Institute (EBRI) maintains a wealth of data collected from various health savings account (HSA) providers. The EBRI HSA Database contains 2.9 million accounts with total assets of $5 billion as of Dec. 31, 2014. This Issue Brief is the second annual report drawing on cross-sectional data from the EBRI HSA Database. It examines account balances, individual and employer contributions, annual distributions, investment accounts, and account-owner demographics for 2014. Enrollment in HSA-eligible health plans is estimated to be about 17 million policyholders and their dependents, and it has also been estimated that there are 13.8 million accounts holding $24.2 billion in assets as of Dec. 31, 2014. Almost 4 in 5 HSAs have been opened since the beginning of 2011. The average HSA balance at the end of 2014 was $1,933, up from $1,408 at the beginning of the year. Average account balances increased with the age of the owner of the account. Account balances averaged $655 for owners under age 25 and $5,016 for owners ages 65 and older. About 6 percent of HSAs had an associated investment account. End-of-year 2014 balance averages were higher in accounts with investment assets. Thirty-seven percent of HSAs with investment assets ended 2014 with a balance of $10,000 or more, whereas only 4 percent of HSAs without investment assets had such a balance. Among HSAs with investment assets, accounts opened in 2014 ended the year with an average balance of $6,544; whereas those opened in 2005 had an average balance of $19,269 at the end of 2014. HSAs with either individual or employer contributions accounted for 70 percent of all accounts and 86 percent of the assets in 2014. Four percent of these accounts ended the year with a zero balance. On a yearly average, individuals who made contributions deposited $2,096 to their account. HSAs receiving employer contributions received $1,021 a year, on average. Four-fifths of HSAs with a contribution also had a distribution for a health care claim during 2014. Among HSAs with claims, the average amount distributed for health care claims was $1,951. Distributions for health care claims increased with age, with the exception of those ages 65 and older. Average annual distributions were $636 for account owners under age 25; $2,373 for account owners ages 55-64; and $2,124 for account owners ages 65 and older. Average annual distributions were higher for accounts that were older. However, the likelihood of taking a distribution for health care claims was higher among accounts opened more recently.

Consumer-directed health plans reduce the long-term use of outpatient physician visits and prescription drugs.

Consumer-directed health plans (CDHPs) are designed to make employees more cost- and health-conscious by exposing them more directly to the costs of their care, which should lower demand for care and, in turn, control premium growth. These features have made consumer-directed plans increasingly attractive to employers. We explored effects of consumer-directed health plans on health care and preventive care use, using data from two large employers-one that adopted a CDHP in 2007 and another with no CDHP. Our study had mixed results relative to expectations. After four years under the CDHP, there were 0.26 fewer physician office visits per enrollee per year and 0.85 fewer prescriptions filled, but there were 0.018 more emergency department visits. Also, the likelihood of receiving recommended cancer screenings was lower under the CDHP after one year and, even after recovering somewhat, still lower than baseline at the study's conclusion. If CDHPs succeed in getting people to make more cost-sensitive decisions, plan sponsors will have to design plans to incentivize primary care and prevention and educate members about what the plan covers.

Problems and the potential direction of reforms for the current individual medical savings accounts in the Chinese health care system.

Individual health savings accounts are an important part of the current basic medical insurance system for urban workers in China. Since 1998 when the system of personal medical insurance accounts was first implemented, there has been considerable controversy over its function and significance within different social communities. This paper analyzes the main problems in the practical implementation of individual medical insurance accounts and discusses the social and cultural foundations for the establishment of family health savings accounts from the perspective of Chinese Confucian familism. Accordingly, it addresses the direction of the reform and the development of the current system of individual health insurance accounts in China.

Health savings accounts and health reimbursement arrangements: assets, account balances, and rollovers, 2006-2011.

ASSET LEVELS GROWING: In 2011, there was $12.4 billion in health savings accounts (HSAs) and health reimbursement arrangements (HRAs), spread across 8.4 million accounts, according to data from the 2011 EBRI/MGA Consumer Engagement in Health Care Survey, sponsored by EBRI and Matthew Greenwald & Associates. This is up from 2006, when there were 1.3 million accounts with $873.4 million in assets, and 2010, when 5.4 million accounts held $7.3 billion in assets. AFTER LEVELING OFF, AVERAGE ACCOUNT BALANCES INCREASED: After average account balances leveled off in 2008 and 2009, and fell slightly in 2010, they increased in 2011. In 2006, account balances averaged $696. They increased to $1,320 in 2007, a 90 percent increase. Account balances averaged $1,356 in 2008 and $1,419 in 2009, 3 percent and 5 percent increases, respectively. In 2010, average account balances fell to $1,355, down 4.5 percent from the previous year. In 2011, average account balances increased to $1,470, a 9 percent increase from 2010. TOTAL AND AVERAGE ROLLOVERS INCREASE: After declining to $1,029 in 2010, average rollover amounts increased to $1,208 in 2011. Total assets being rolled over increased as well: $6.7 billion was rolled over in 2011, up from $3.7 billion in 2010. The percentage of individuals without a rollover remained at 13 percent in 2011. HEALTHY BEHAVIOR DOES NOT MEAN HIGHER ACCOUNT BALANCES AND HIGHER ROLLOVERS: Individuals who smoke have more money in their accounts than those who do not smoke. In contrast, obese individuals have less money in their account than the nonobese. There is very little difference in account balances by level of exercise. Very small differences were found in account balances and rollover amounts between individuals who used cost or quality information, compared with those who did not use such information. However, next to no relationship was found between either account balance or rollover amounts and various cost-conscious behaviors. When a difference was found, those exhibiting the cost-conscious behavior were found to have lower account balances and rollover amounts. DIFFERENCES IN ACCOUNT BALANCES: Men have higher account balances than women, older individuals have higher account balances than younger ones, account balances increase with household income, and education has a significant impact on account balances independent of income and other variables. DIFFERENCES IN ROLLOVER AMOUNTS: Men rolled over more money than women, and older individuals had higher rollover amounts than younger individuals. Rollover amounts increase with household income and education, and individuals with single coverage rolled over a slightly higher amount than those with family coverage.

Health savings accounts and health reimbursement arrangements: assets, account balances, and rollovers, 2006-2010.

ASSET LEVELS GROWING: In 2010, there was $7.7 billion in health savings accounts (HSAs) and health reimbursement arrangements (HRAs), spread across 5.7 million accounts. This is up from 2006, when there were 1.2 million accounts with $835.4 million in assets, and 2009, when 5 million accounts held $7.1 billion in assets. AFTER LEVELING OFF, AVERAGE ACCOUNT BALANCE DROPS SLIGHTLY: Increases in average account balances leveled off in 2008 and 2009, and fell slightly in 2010. In 2006, account balances averaged $696. They increased to $1,320 in 2007, a 90 percent increase. Account balances averaged $1,356 in 2008 and $1,419 in 2009, 3 percent and 5 percent increases, respectively. In 2010, average account balances fell to $1,355, down 4.5 percent from the previous year. AVERAGE ROLLOVER DECLINES, WHILE TOTAL ROLLOVERS INCREASE: Despite a decline in the average rollover amount in 2010, total assets being rolled over have been increasing. $4.2 billion was rolled over in 2010, up from $4 billion in 2009. The average rollover increased from $592 in 2006 to $1,295 in 2009, and fell to $1,029 in 2010. The percentage of individuals without a rollover decreased from 23 percent in 2006 to 10 percent in 2009 and increased slightly to 13 percent in 2010. HEALTHY BEHAVIOR MEANS HIGHER ACCOUNT BALANCES AND HIGHER ROLLOVERS: Individuals who exercised, those who did not smoke, and those who were not obese had higher account balances and higher rollovers than those with less healthy behaviors. It was also found that individuals who used cost or quality information had higher account balances and higher rollovers compared with those who did not use such information. However, no relationship was found between either account balance or rollover amounts and various cost-conscious behaviors such as checking pricing before getting services or asking for generic drugs instead of brand names, among other things. DIFFERENCES IN ACCOUNT BALANCES: Men have higher account balances than women, older individuals have higher account balances than younger ones, account balances increase with household income, and education has a significant impact on account balances independent of income and other variables. DIFFERENCES IN ROLLOVER AMOUNTS: Men rolled over more money than women, and older individuals had higher rollover amounts than younger individuals. Rollover amounts increase with household income and education, and individuals with single coverage rolled over a higher amount than those with family coverage.

Health savings accounts: back to the future.

Health savings accounts (HSAs) have altered the health care landscape in ways no one might have predicted. HSAs have emerged as a valuable tool in the quest to change consumers' health care spending behaviors and better manage health care costs. This article compares and contrasts HSAs to other health care spending accounts, addresses various HSA topics in the context of HSAs' first six years, and speculates on the future of HSAs. The authors identify policy changes that could help expand HSAs, drive further employer savings, make HSAs more user-friendly, impact employee satisfaction and increase adoption rates.