Health savings accounts: description, analysis, and implications

Health savings accounts (HSAs) were authorized in federal legislation in 2003 and became effective January 1, 2004. The principal motive was to encourage working-age persons to be more cost conscious and to make more prudent health care spending decisions, thereby restraining growth in health care spending. A secondary motive was to make it easier for individuals to accumulate funds over time to be used for paying for health care. As of March 2005, enrollment in HSAs exceeded 1 million. Contributions to HSAs can be made by individuals or employers. Neither contributions nor withdrawals for qualified health care expenses are subject to federal taxation. Unused funds can be carried over to the next year or to another employer; this feature makes HSAs more attractive than other types of health spending accounts. An HSA must be coupled with a high-deductible health plan. The out-of-pocket spending gap between the annual HSA contribution and the minimum deductible is intended to make people more cost conscious in their health spending decisions. Prototypes of HSAs have been tried on a limited basis in the private sector, and these provide some lessons for the likely effects of HSAs on the socioeconomics of enrollment; the type and timing of health care spending; health outcomes; and effects on individuals, employers, and providers.