There has been much fuss about the HSA, with some estimates suggesting more than 1 million accounts were opened in 2005. But the majority of those have been opened by people who already had high-deducible plans. However, as companies like UnitedHealth Group, Aetna and Cigna push these consumer-directed plans to their mainstream employer clients, they are gong to face two challenges. The first will be to educate Americans about how to evaluate the healthcare services they are asking for and receiving. The second will be to deal with the care of those sick people who have blown through the deductible, which account for the vast majority of healthcare costs.
Early indications are that plans will try to combine consumer-directed health plans (CDHPs) with old style managed care techniques of restricting access to specialists and differential pricing based on network tiers. It will be interesting to see how far this goes, and more particularly what the reaction from providers and patients will be a decade after the "backlash against managed care."