As we enter the fourth quarter, it might be helpful to take a look at some of the consumer-driven strategies we've considered in the past—as well as some we've avoided—and see if they might be a good option for our clients both this coming year and when all hell breaks loose in 2014.

Past

We first dipped our toes into the consumer-driven pool back in the 1970s with flexible spending accounts. While some would argue FSAs aren't really a consumer-driven approach at all (after all, they do encourage us to go on a spending spree at the end of the year if we over-estimate how much we're going to spend on medical services), FSAs do make us think about our expected expenses ahead of time, and that's more than most people normally do.

We kicked it up a notch with health reimbursement arrangements when the government ruled in 2002 that unused funds could roll over to the next year. With this ruling, HRAs accomplished something that FSAs by design could not – they encouraged people to shop around, to be wise consumers, and to save some of their money: “the less someone spends this year, the more they'll have next year” was the idea. Of course, for the consumer, there's no real planning with an HRA since the employer – not the employee – funds the account, so we sort of took one step forward and two steps back. Not only was the up-front planning eliminated, the employee wasn't even contributing her own funds to the account.

With the advent of health savings accounts in 2004, we got the best of both worlds—people could plan ahead and set aside their own money on a tax-free basis to use for qualified medical expenses, but because unused funds roll over from year to year, they weren't encouraged to act like animals and spend every penny in the account before the end of the year.