Specifically, the authors of the AJMC study found that when the co-payments were raised from $10 to $20, the portion of patients who took their full course of medication dropped by between 6 and 10 percentage points. The researchers also found that compared with patients who weren't taking their medications properly, high-risk heart-patients who completed their full course of treatment suffered 357 fewer hospitalizations per 1,000 cases each year.

Fewer hospitalizations, of course would lead to lower health-care costs in the long run. Interestingly, however, the AJMC authors wouldn't do away with these co-payments entirely; they'd fine-tune them. By eliminating co-payments for high-risk and medium-risk patients but raising them from $10 to $22 for low-risk patients, they argue, plan sponsors and insurers could eliminate nearly 80,000 hospitalizations and 31,000 other hospital visits per year. Total annual saving: $1 billion.

Along those lines, Segal's Kaplan says that some employers have contemplated a "tiered" health plan that would offer higher coverage for conditions that have a higher overall medical risk. For instance, he suggests, such a plan might pay for 90 percent of the care for cancer or heart disease but only 50 percent for asthma or dermatological therapy.

Even those who favor other types of plans acknowledge the appeal of HSAs for certain people. One benefit design that Kaplan especially favors is a "personalized PPO" plan, in which participants choose from various levels of co-payments deductibles, and coverage. In other words, he says, participants select the kind of insurance they want rather than make the direct cost choices about medical care that are required with an HSA.

Nevertheless, among the levels of coverage in the personalized plans, there's a place for the healthy employee with an appetite for risk: a health savings account, complete with high-deductible coverage, can be made available.

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