Consumers who have traditional health coverage say they're having more problems with getting care; consumers with health savings account (HSA) or health reimbursement arrangement (HRA) plans say they're having fewer problems.
Paul Fronstin, an analyst at the Employee Benefit Research Institute (EBRI), has published data on the health account effect in a report on trends in U.S. health care access.
Fronstin found that consumers in health account plans are the only ones who seemed to be having better luck with care in 2011 than in 2010, and that the consumers seeing the most improvement are those at employers that contribute $1,000 or more per year to their health accounts.
Fronstin based the paper on data from one set of surveys conducted from 2005 to 2007 and another set conducted from 2008 to 2011. Each survey sample included about 1,000 privately insured U.S. adults ages 21 to 64.
Researchers divided the survey participants into three categories: Those with traditional, low-deductible health insurance; those with high-deductible coverage and no HSA or HRA; and those with both high-deductible coverage and health accounts.
EBRI measured health care access problems by asking participants whether they had delayed or avoided getting medical care due to cost. EBRI also asked the participants whether they had failed to fill a prescription because of cost or skipped doses to make the medication last longer.
Participants with traditional insurance were doing about the same in 2011 as in previous years, but a little worse than in 2010.
The percentage of those participants reporting access problems increased to 31% in 2011, from 28% in 2010. The percentage reporting problems was up from 29% in 2005.
Participants with high-deductible coverage and no health accounts were doing a little worse than in 2005 and a little better than in 2010.
For high-deductible-coverage-only participants, the percentage reporting access problems in 2011 was 42%. That was up from 39% in 2010 and down from 44% in 2005.
Participants with health account coverage were doing considerably better than in 2005 and in 2010.
About 36% of the health account participants said they had experienced access problems. That was down from 38% in 2010, and down sharply from 48% in 2005. The percentage who said they had delayed or avoided getting care in 2011 due to cost was 21% -- down a bit from 23% in 2010, and down dramatically from 37% in 2005.
Health account holders with employers who contributed to their accounts were doing much better at getting care than holders with employers that did not fund their accounts, and holders with employers that contributed $1,000 or more per year to the accounts did better than those employers that contributed less.
About 33% of health account holders with employers that contributed $1,000 or more reported access problems, down from 42% in 2010.
The percentage of holders with employers that contributed less than $1,000 who had access problems increased to 38%, from 37%. The access problem rate for account holders who received no employer contributions increased to 41%, from 38%.
"Access issues appear to have fallen over time for those holding the accounts for one to two years and three or more years, but not for those with accounts for less than a year," Fronstin says in a discussion of the results.