HRAs are great, as long as they are used in a proper manner.

The premise behind the CDH acronym family (HRA, HDHP and HSA) was to change the patient's behavior from an inefficient "all you can eat buffet" mentality of health care consumption to a more efficient "use what you really need" attitude.

Certainly the HSA and traditional "front end" HRA paired with a no-co-pay plan accomplishes this (assuming a reasonable cost-sharing level in the deductible). However, what exactly does a higher deductible plan, with co-pays with a "back end" HRA, accomplish?

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