It looks like consumers are finally starting to drive their ownhealth care.

A new report shows that just last year, Americans socked away awhopping $12.4 billion in 8.4 million health savings andreimbursement accounts last year. That’s up from 1.3 millionaccounts full of $873.4 million in assets just five years ago.

Read "JPMorgan HSA use surges" and "Bankof America sees record HSA growth"]

Now these aren’t exactly Apple earnings report-type numbers, butthey’re certainly impressive for a country full of spenders. Thesenew numbers come from the just-published “2011 Consumer Engagementin Health Care Survey,” sponsored by the Employee Benefit ResearchInstitutee and Mathew Greenwald and Associates.

The average account balance sat at $1,470 last year, a slightdip but more than double the 2006 average of $696.

The growth of at least these two consumer-driven plans inparticular becomes even more impressive considering how young theyboth still are.

Health reimbursement accounts emerged back in 2001, with just asmattering of employers actually offering these payback-typeplans.

Congress actually wrote health savings accounts into law a fewyears later and they came online in 2004 as a health care expenseversion of the 401(k).

The logic, of course, behind these and other consumer-drivenvehicles is that by managing and spending their own money whenusing their health care services, consumers will act and spend moreresponsibly.

“The increase in asset levels in HRAs and HSAs in 2011 points toa new growth phase for consumer-directed health care plans,”explains Scott Mardis, senior vice president for businessdevelopment at AmeriFlex. “Flat increases in 2008–2010 were aresult of misaligned health care premiums and health care reformprovisions that created a ‘wait and see’ attitude among brokers andemployers. Now, with the proper alignment of carrier premiums,market place conditions and improved education, consumer-directedplans are finally poised to take their place as the premierdelivery system for insurance plans.”

According to the experts at Mercer, by 2010, 16 percent of smallto mid-sized employers and 23 percent of large employers offered anHSA or HRA-eligible plan, which EBRI estimates covers 21 millionAmericans and making up 12 percent of the private insurancemarket.

“Over time, balances have increased. What that shows is thatpeople are saving more than they’re spending. That’s in a downeconomy when people have negative savings rates. [It] shows theseplans are working,” says Eric Johnson, HealthEquity’s director ofeducation.

But before delving further, a couple of questions come to mind.For starters, why lump HSAs—individually owned products—withHRAs—which aren’t, but can be rolled over? Though that’s dictatedby the individual employer.

And, even assuming that, as one broker pointed out, “the numbersseem off,” a hunch that bears itself out when you look at AHIP’snumbers from November. America’s Health Insurance Plans’ own studycounts 11.4 million HSAs alone, which is still larger than EBRI’sestimate of HSAs and HRAs combined.

The folks at EBRI didn’t return calls for comment on thisstudy.

A few surprises

Statistical anomalies aside, this study still shows stronggrowth and wider acceptance of a burgeoning market. It also digsdeeper than most surveys of this niche.

“What’s interesting about this study is they looked at thedemographics of people who have HSAs,” Johnson adds. “And I thinkthe conclusion they reach is that HSAs aren’t just for one group ofpeople. Some think HSAs are just good for healthy people, otherssay they’re only for the wealthy; others believe younger peoplewill do better than older people. But those myths are proven wrongby this study. It seems they can be good for everyone—young or old,rich or poor, healthy or unhealthy.”

Part of those “demographics” include revelations such as mencarrying higher account balances than women, much like olderconsumers versus younger ones and a direct correlation betweenhousehold incomes and account balances.

In particular, as of August, the study shows men with an averageaccount balance of $1,735 while women only averaged about $1,403.Of course, the conventional wisdom here points to a lowerutilization rate for men, resulting in higher average accountbalances.

Of course, as Johnson points out, there can be several factorsthat create this result: This could point to single-income earners(i.e. men) assuming family coverage and chipping in more to covertheir entire family’s expenses; men typically earn more than women,so they end up saving more in the first place; more men work foremployers who contribute to their employees’ HSAs; or more men payout-of-pocket to pay for HSA-eligible expenses and hang on to thereceipts so they can reimburse themselves at a later time.

Some other demographic nuggets shaken out of the studyinclude:

Last year whites surged ahead of blacks to boast higher averageaccount balances for the first time since 2008.

Older consumers typically have more socked away.

Higher household incomes translated into higher average HSA/HRAaccount balances—of course, that could also mean those householdsare better equipped to pay for medical expenses out of their ownpockets.

Higher education translates directly into higher average accountbalances, too.

Perhaps the biggest surprise tucked away among all the numberssprung out of the health behaviors category where, apparently,smokers plan ahead by socking more of their money away in accountsthan non-smokers. But on the flip side, obese consumers havethinner accounts than the non-obese.

Economic immunity?

Heading into this dense survey, one would assume the economicmalaise that’s plagued the rest of us for the last half decadewould bleed over into health savings and reimbursement accounts.Just look at what kind of havoc it’s wreaked on 401(k)s.

But one would be wrong. In fact, except for a slight hiccup backin 2010, growth has been as slow and steady as your cable bill.

“I think that the increases we are seeing in the average HSAbalance is due to a couple of factors,” explains industry veteranMarty Trussell. “First, people are gaining experience with usingHSAs and feel more confident in adding dollars to the account sincethey know they won’t be lost at year-end. Secondly, I think thatfinancial advisers are becoming more active in advising theirclients to sign-up for an HSA and fund it to the maximum as theywould a 401(k).”

But there’s got be more to it than that, right?

“They’ve gone mainstream,” Care Advocates’ Sharon Alt says. “Ithink what you’re really seeing here—quite simply—is the maturationof these products. People are finally getting it.”

But there’s also the little matter of the Patient Protection andAffordable Care Act, which has clearly moved employers andemployees alike toward consumer-driven options. And while it mightnot be the main driver of HSA and HRA growth, it’s certainly amitigating factor.

PPACA was supposed to slash premiums—or at least slow theincreases. It is called affordable care, after all. But we’re stillwaiting, as premiums keep climbing. So employers responded bybumping up deductibles and shifting more responsibility toemployees themselves.

“This is a cause and effect we see every day, and it’s certainlyplayed its part in encouraging the wider adoption ofconsumer-driven accounts,” Alt says. “When you look at all premiumsand deductible pressures employees are facing now, it makes sensethey’d start socking more of the pre-tax dollars away to cover itall.”

Another overlooked factor could be an overall dip inutilization, which this study might not address but can easily beread between the lines.

Good news, good news

This survey—despite quibbles over the totals andmethodology—clearly shows that these bedrock consumer-driven healthplans are here to stay. Better yet, everybody wins.

Obviously, employers save big on their bottom lines. And on theflip side, employees almost always perform better—taking bettercare of themselves—when they’re on an HSA or HRA and utilizationdrops.

Of course, this also highlights the role of the broker, who’sactually morphing into more of an adviser. How active–andvaluable–a role that turns out to be is up to the individualbroker.

Read Storey's blog, "Consumers—andemployees—are ready to drive"]