One of the on-going concerns among critics of Health Savings Accounts is that the incentive to spend wisely on your health care needs, which is one of the key features of an HSA — really will become an incentive not to spend money on your health care or the health care of someone in your family. This is not true, and here are the economic incentives, that prevent this from happening, in most cases.

Consider the following: anyone who has gone out to dinner on an expense account orders their food differently than if they were paying for it themselves. When someone else is paying, you order more food, and more expensive food, with more to drink, a dessert and coffee.

When someone else is paying the health care bill, the resulting incentive for the patient is the same — they consume more health care services, and more expensive health care services. Recent studies cited by Blue Cross Blue Shield put that number at 30% more care than needed. Not surprisingly, the utilization rate (the rate at which health care services are consumed or utilized) by patients with an HSA is about 25% to 30% less than those with a traditional health plan.

In fact, this same dynamic works among senior citizens on Medicare. Those seniors who do not have a Medicare supplemental policy that pays the Medicare deductibles cost Medicare about $1,400 less per year than those seniors with a Medicare supplemental policy.

But, there are those who believe that this dynamic makes people not spend their health care money when they should — and their is no talking them out of this view — even though it makes no sense whatsoever.

Here is why: if I have an HSA then I have a financial incentive to be healthy. (It will cost me less money, since if I get unhealthy, I pay.) Therefore, those with an HSA have a financial incentive to pursue their preventive care more diligently than those who do not have an HSA.

In fact, this is borne out by market experience. Those with an HSA utilize their preventive care at a much higher rate than those without an HSA — when you compare HSA policy holders to other policy holders with first dollar preventive care coverage.

This is because of the economic incentive not to get sick, and preventive care will prevent big bills. HSA policy holders understand this, which is why they use more preventative care services.

The whole reason that preventive care is the ONLY exception to the rule allowing no benefit coverage below the deductible, was to make peace with those who thought HSAs would cause people to spend less on preventive care.

The higher utilization rate of preventive care for those with HSAs is not the only change in behavior among patients. Those who are less healthy and who have an HSA are more faithful to their treatment regimes for whatever health care ailment they have — because it pays them not to let their treatments slide.

This explains why people with an HSA have fewer emergency room visits and are more faithful prescription drug taking and more regular care of their health. Why? Because they will pay otherwise.

This means that HSAs provide an incentive — a financial incentive — to those who are less healthy to take care of themselves and it shows, when you compare a less healthy HSA population with a less healthy population of those with traditional health plans.

So, the news from HR.com that most HSAs provide first dollar preventive care coverage is not really news, the market is doing exactly what Congress wanted the market to do when Congress designed Health Savings Accounts, but it is worthwhile understanding why Congress designed HSAs to allow for first dollar preventive care.