The move toward high-deductible health plans has fueled growing interest in companion health savings accounts (HSAs). Yet as more and more Americans take a hands-on approach to their health care and more insurance companies move towards higher deductibles, they are finding that their local banks can’t meet their needs.

The HSA is a relatively new financial product, first established in 2003 as part of a larger piece of health care legislation. The idea behind the HSA – a tax-advantaged medical savings account available to people enrolled in those high-deductible plans – is essentially to increase efficiency in the health care system. The HSA is supposed to encourage consumers to save for future health care expenses and take more responsibility for their own health care.

Yet it took a little while for the HSA to take off.

“It took about five years for plan sponsors to really understand it. Then it took another five years for ordinary mortals like you and me to understand it and start to use it,” said Bob Kaiser, head of relationship management for health benefit solutions at Bank of America Merrill Lynch. “Now it’s on fire and it’s really become an important part of the benefits offerings from most of the larger employers.”

Membership in high-deductible health plans (or HDHPs, for short) is on the upswing. According to the Center for Health Information and Analysis (CHIA), membership in HDHPs increased across all employer sizes from 2011 to 2013, the latest figures available. Membership was particularly concentrated among small and mid-sized employers (38 percent and 45 percent, respectively), although HDHP adoption over that period grew the fastest among larger employers, CHIA said.

That’s not exclusive to Massachusetts, either. Last year, HDHPs made up about 85 percent of all health insurance plans sold via the Affordable Care Act’s health insurance exchanges.

Myriad factors are driving the migration to HDHPs, but the simplest is cost. The basic idea at the root of the HDHP is that the high-deductible will force Americans to use health care services more judiciously since they have a greater financial stake in the matter.

That’s not a new idea. The Rand Health Insurance Experiment, which launched in 1971, tracked the behaviors of nearly 6,000 people randomly assigned to insurance plans with varying levels of cost-sharing, or no cost-sharing whatsoever. The experiment, which is of course not without its criticisms, essentially found that medical cost-sharing reduced unnecessary medical care (also known as overutilization), though on the flipside, it also reduced necessary medical care.

Beyond the increasing cost of health care and the consumerist motive behind HDHPs, employers have increasingly moved toward those high-deductible plans in anticipation of the so-called “Cadillac tax,” a provision of the Affordable Care Act that will impose a 40 percent excise tax on employers offering especially benefit-rich plans beginning in 2018.

Costs Versus Rewards

This brings us back to the HSA, which may or may not be available at your hometown community bank. On its face, it almost sounds like a no-brainer: This product is taking off, so why wouldn’t every bank want to offer it?

Of course, the reality is a bit more complex – and much of it comes back down to a common complaint among bankers: the cost of compliance.

“There’s a lot of regulation because it’s a tax advantaged account and it’s tied to a medical insurance product, so we need to make sure we’re giving our customers instructions around how to use the HSA correctly. … We have to make sure we’re current with the regulations, that we’re properly trained and that we give you information that’s easy to distill down so you can comprehend and take correct action on it,” said Liz Ryan, head of the health benefit services group at Wells Fargo. “Keeping up with the regulations, keeping up with the compliance can be expensive and it could create barriers for [financial institutions] wanting to get into offering that service.”

That means a huge investment in technology – so that customers can learn about the product on whatever channel they choose – and in people. Kaiser, however, had a different take on that.

“If you’re a financial institution, quite frankly, it’s a layup. It’s pretty easy to do. You’ve got consumer education, you’ve got a payment system and we like to have investments,” he said. “All those things are just natural elements of a financial institution.”

He estimated that Bank of America Merrill Lynch’s HSA business has grown around 20 percent every year since the bank began offering it 10 years ago.

Meanwhile, Wells Fargo today has more than 600,000 individuals enrolled in its HSA, totaling around $1.7 billion in assets under management.

“Last year we had our strongest enrollment season ever. Our accounts grew over 30 percent and assets under management grew 32 percent,” Ryan said. “As to the future, we’re very bullish on the prospects for what the HSA look like.”