After several consecutive years of double-digit premium increases, employer-sponsored health insurance is again coming under intense scrutiny in the United States. But a remedy might be emerging in the form of consumer-driven health plans. This new type of insurance combines a high-deductible policy1 with a tax-exempt health savings account (HSA) and gives consumers more responsibility for managing their spending on health care.2 Early results suggest that these plans could slow the rise in costs by lowering demand and prompt hospitals and other medical professionals to improve the quality of care.
Efforts to reform the US health care system aren't new of course—rising costs have sparked major reforms in each of the past several decades (Exhibit 1). Although none succeeded in controlling cost increases for more than a few years, they have cumulatively reshuffled the competitive positions of payers (mainly insurance companies) and providers (doctors, hospitals, clinical laboratories, and drug companies). The United States might now be on the cusp of another big change as high absolute levels of health spending and continuing annual premium increases make health benefits less and less affordable for employers and employees alike.