Dahlia Remler and Sherry Glied are respected researchers who have assessed who wins and who loses with Health Savings Accounts in their Health Affairs article, “How much more cost sharing will health savings accounts bring?” But the tone and selective interpretation of their study reported in John Berry’s August 3 column distorts their results.
Remler and Glied find that healthier patients come out ahead, largely because they get a bigger break from shielding their HSA deposits from taxes. They also found that the very sick come out ahead financially because the limits on overall out-of-pocket costs with HSAs are often less than limits on conventional insurance policies.
But they observed that reducing cost sharing for “those high spenders who are responsible for a large share of overall health spending” could turn back the clock on lessons learned from the Rand experiment. The losers in their study were patients with mild chronic conditions who are likely to spend more with HSAs. But we believe these are also the patients who might respond best to incentives to become more involved in their care management and to seek out more economical treatment alternatives.