How can we control health care costs and at the same time improve quality and create greater access to care? Answer: Give patients control over more of the health care dollars.
Right now Health Savings Accounts are primarily being used by patients to pay small medical bills below the deductible. But they could and should be used in just about every aspect of medicine, including expensive surgery, chronic illness, custodial care and even emergency room visits.
For example, there is mounting evidence that patients suffering from diabetes, heart disease, cancer and other chronic illnesses can (with training) manage a lot of their own care as well or better than traditional doctor therapy. If they are going to manage their own care, they will do an even better job if they are also managing the money that pays for that care.
In addition, there is no reason why patients could not manage almost all the money used for primary care, including routine doctor visits and most diagnostic tests spending from an HSA that they own and control. If patients are controlling the money, everything will cost less. They will substitute less expensive phone and email consultations for doctor office visits; they will shop for better options for everything from blood tests to mammograms; and they will opt for walk-in clinics and free standing emergency care instead of hospital emergency rooms, when appropriate.