Abstract: The present invention relates to a real time account control method and system that allows only eligible and authorized items to be purchased using the account. The present invention relates particularly to healthcare spending accounts such as flexible spending accounts and health reimbursement arrangements. The method can comprise the steps of: establishing at least one account, each account having an account holder; identifying at least one item eligible for purchase using one of the accounts; identifying at least one item authorized for purchase using one of the accounts; and, upon request to purchase an item using one of the accounts, authorizing the purchase for an amount not to exceed an available balance in that account only if the item is both an item identified as eligible for purchase and an item authorized for purchase. The system includes a point of sale system having at least one input device and a processor system.