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Medical savings accounts: assessing their impact on efficiency, equity and financial protection in health care

Published online by Cambridge University Press:  17 February 2016

Olivier J. Wouters ,
Jonathan Cylus ,
Wei Yang ,
Sarah Thomson  and
Martin McKee
Olivier J. Wouters*
Affiliation:
LSE Health, London School of Economics and Political Science, London, UK
Jonathan Cylus
Affiliation:
LSE Health, London School of Economics and Political Science, London, UK European Observatory on Health Systems and Policies, London, UK
Wei Yang
Affiliation:
LSE Health, London School of Economics and Political Science, London, UK Centre for Health Services Studies, University of Kent, Kent, UK
Sarah Thomson
Affiliation:
LSE Health, London School of Economics and Political Science, London, UK European Observatory on Health Systems and Policies, London, UK WHO Barcelona Office for Health Systems Strengthening, Barcelona, Spain
Martin McKee
Affiliation:
European Observatory on Health Systems and Policies, London, UK London School of Hygiene and Tropical Medicine, London, UK
*
*Correspondence to: Olivier J. Wouters, Researcher, LSE Health and Social Care, Cowdray House, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK. Email: O.J.Wouters@lse.ac.uk
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Abstract

Medical savings accounts (MSAs) allow enrolees to withdraw money from earmarked funds to pay for health care. The accounts are usually accompanied by out-of-pocket payments and a high-deductible insurance plan. This article reviews the association of MSAs with efficiency, equity, and financial protection. We draw on evidence from four countries where MSAs play a significant role in the financing of health care: China, Singapore, South Africa, and the United States of America. The available evidence suggests that MSA schemes have generally been inefficient and inequitable and have not provided adequate financial protection. The impact of these schemes on long-term health-care costs is unclear. Policymakers and others proposing the expansion of MSAs should make explicit what they seek to achieve given the shortcomings of the accounts.

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Perspective
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Health Economics, Policy and Law , Volume 11 , Issue 3 , July 2016 , pp. 321 - 335
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© Cambridge University Press 2016 

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