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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.

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

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References

Asher, M. and Nandy, A. (2006), ‘Health financing in Singapore: a case for systematic reforms’, International Social Security Review, 59(1): 75–92.CrossRefGoogle Scholar
Asher, M., Ramesh, M. and Maresso, A. (2008), ‘Medical savings accounts in Singapore’, Euro Observer, 10(4): 9–11.Google Scholar
Baicker, K., Dow, W. H. and Wolfson, J. (2007), ‘Lowering the barriers to consumer-directed health care: responding to concerns’, Health Affairs, 26(5): 1328–1332.CrossRefGoogle ScholarPubMed
Barr, M. (2001), ‘Medical savings accounts in Singapore: a critical inquiry’, Journal of Health Politics, Policy and Law, 26(4): 709–726.CrossRefGoogle Scholar
Bloche, M. G. (2006), ‘Consumer-directed health care’, New England Journal of Medicine, 355: 1756–1759.CrossRefGoogle ScholarPubMed
Bloche, M. G. (2007), ‘Consumer-directed health care’, Health Affairs, 26(5): 1315–1327.CrossRefGoogle ScholarPubMed
Buchmueller, T. C. (2008), ‘Consumer-oriented health care reform strategies: a review of the evidence on managed competition and consumer-directed health insurance’, Milbank Quarterly, 87(4): 820–841.CrossRefGoogle Scholar
Buntin, M. B., Damberg, C., Haviland, A., Kapur, K., Lurie, N., McDevitt, R. and Marquis, M. S. (2006), ‘Consumer-directed health care: early evidence about effects on cost and quality’, Health Affairs, 25(6): w516–w530.CrossRefGoogle ScholarPubMed
Buntin, M. B., Haviland, A. M., McDevitt, R. and Sood, N. (2011), ‘Healthcare spending and preventive care in high-deductible and consumer-directed health plans’, American Journal of Managed Care, 17(3): 222–230.Google Scholar
Charlton, M. E., Levy, B. T., High, R. R., Schneider, J. E. and Brooks, J. M. (2011), ‘Effects of health savings account-eligible plans on utilization and expenditures’, American Journal of Managed Care, 17(1): 79–86.Google ScholarPubMed
Chen, S., Lo Sasso, A. T. and Nandam, A. (2013), ‘Who funds their health savings account and why?’, International Journal of Health Care Finance & Economics, 13(3–4): 219–232.CrossRefGoogle ScholarPubMed
Chia, N. C. and Tsui, A. K. (2005), ‘Medical savings accounts in Singapore: how much is adequate?’, Journal of Health Economics, 24: 855–875.CrossRefGoogle ScholarPubMed
Cress, J. R. and Zimmer, D. M. (2011), ‘Medical savings accounts and preventive health care utilization’, Journal of Economics and Management, 7(1): 1–22.Google Scholar
Cylus, J. and Thomson, S. (2012), ‘Medical savings accounts’. Background paper prepared for a Senior Policy Seminar in Bishkek, Kyrgyzstan, 29–30 November, on behalf of the WHO Regional Office for Europe.Google Scholar
Davis, K. (2004), ‘Consumer-directed health care: will it improve health system performance?’, Health Services Research, 39(4 Pt 2): 1219–1234.CrossRefGoogle ScholarPubMed
Dixon, A. (2002), ‘Are medical savings accounts a viable option for funding health care?’, Croatian Medical Journal, 43(4): 408–416.Google ScholarPubMed
Dixon, A., Greene, J. and Hibbard, J. (2008), ‘Do consumer-directed health plans drive changes in enrollees’ health care behavior?’, Health Affairs, 27(4): 1120–1131.CrossRefGoogle ScholarPubMed
Fowles, J. B., Kind, E. A., Braun, B. L. and Bertko, J. (2004), ‘Early experience with employee choice of consumer-directed health plans and satisfaction with enrolment’, Health Services Research, 39(4): 1141–1158.CrossRefGoogle Scholar
Fronstin, P. (2012), ‘Health savings accounts and health reimbursement arrangements: assets, account balances, and rollovers, 2006-2011’, Employee Benefit Research Institute, 367(Issue Brief): 1–28.Google Scholar
Fronstin, P. (2014), ‘Lifetime accumulations and tax savings from HSA contributions’, Employee Benefit Research Institute Notes, 35(7): 1–24.Google Scholar
Fronstin, P., Sepúlveda, M. J. and Roebuck, M. C. (2013a), Medication utilization and adherence in a health savings account-eligible plan’, American Journal of Managed Care, 19(12): e400–e407.Google Scholar
Fronstin, P., Sepúlveda, M. J. and Roebuck, M. C. (2013b), Consumer-directed health plans reduce the long-term use of outpatient physician visits and prescription drugs’, Health Affairs, 32(6): 1126–1134.CrossRefGoogle ScholarPubMed
Glied, S. (2008), ‘Health savings accounts in the United States’, Euro Observer, 10(4): 5–6.Google Scholar
Glied, S. and Remler, D. (2005), ‘The effect of health savings accounts on health insurance coverage’, The Commonwealth Fund, 811(Issue Brief): 1–8.Google Scholar
Goldsworthy, T. (2014), ‘The NHS is terminally ill—we need a new Healthcare system’. Adam Smith Institute, www.adamsmith.org/blog/uncategorized/the-nhs-is-terminally-ill-we-need-a-new-healthcare-system/ [20 May 2015].Google Scholar
Gramm, P. (1994), ‘Why we need medical savings accounts’, New England Journal of Medicine, 330(24): 1752–1753.CrossRefGoogle ScholarPubMed
Greene, J., Hibbard, J., Murray, J. F., Teutsch, S. M. and Berger, M. L. (2008), ‘The impact of consumer-directed health plans on prescription drug use’, Health Affairs, 27(4): 1111–1119.CrossRefGoogle ScholarPubMed
Greene, J., Hibbard, J. H., Dixon, A. and Tusler, M. (2006), ‘Which consumers are ready for consumer-directed health plans?’, Journal of Consumer Policy, 29(3): 247–262.CrossRefGoogle Scholar
Hardie, N. A., Lo Sasso, A. T., Shah, M. and Levin, R. A. (2010), ‘Behavioral healthcare services use in health savings accounts versus traditional health plans’, Journal of Mental Health Policy and Economics, 13(4): 159–165.Google ScholarPubMed
Haseltine, W. A. (2013), Affordable Excellence: The Singapore Healthcare Story. Brookings Institution Press, Washington, D.C., 182pp.Google Scholar
Haviland, A. M., Sood, N., McDevitt, R. and Marquis, M. S. (2011), ‘How do consumer-directed health plans affect vulnerable populations?’, Forum for Health Economics and Policy, 14(2): 1–12.Google Scholar
Helmchen, L. A., Brown, D. W., Lurie, I. Z. and Lo Sasso, A. T. (2015), ‘Health savings accounts: growth concentrated among high-income households and large employers’, Health Affairs, 34(9): 1594–1598.CrossRefGoogle ScholarPubMed
Hoffman, C. and Tolbert, J. (2006), ‘Health savings accounts and high deductible health plans: are they an option for low-income families?’, issue paper, Volume 7568. The Henry Kaiser Foundation (KFF), Washington, D.C., 23pp.Google Scholar
Hsiao, W. (1995), ‘Medical savings accounts: lessons from Singapore’, Health Affairs, 14(2): 260–266.CrossRefGoogle ScholarPubMed
Hsiao, W. (2001), ‘Behind the ideology and theory: what is the empirical evidence for medical savings accounts?’, Journal of Health Politics, Policy and Law, 26(4): 733–738.CrossRefGoogle ScholarPubMed
Hurley, J., Guindon, G. E., Rynard, V. and Morgan, S. (2008), ‘Publicly funded medical savings accounts: expenditure and distributional impacts in Ontario, Canada’, Health Economics, 17: 1129–1151.CrossRefGoogle ScholarPubMed
Jost, T. (2005), ‘Consumer-driven health care in South Africa: lessons from comparative health policy studies’, Journal of Health & Biomedical Law, 1(2): 83–109.Google Scholar
Jost, T. (2007), Health Care at Risk: A Critique of the Consumer-Driven Movement, Durham: Duke University Press.Google Scholar
Lee, T. H. and Zapert, K. (2005), ‘Do high-deductible health plans threaten quality of care?’, New England Journal of Medicine, 353: 1202–1204.CrossRefGoogle ScholarPubMed
Lei, X. and Lin, W. (2009), ‘The new cooperative medical scheme in rural China: does more coverage mean more service and better health’, Health Economics, 18: S25–S46.CrossRefGoogle ScholarPubMed
Liu, G. G., Zhao, Z., Cai, R., Yamada, T. and Yamada, T. (2002), ‘Equity in health care access to: assessing the urban health insurance reform in China’, Social Science and Medicine, 55(10): 1779–1794.CrossRefGoogle ScholarPubMed
Liu, J. and Chen, T. (2013), ‘Sleeping money: investigating the huge surpluses of social health insurance in China’, International Journal of Health Care Finance and Economics, 13(3–4): 319–331.CrossRefGoogle ScholarPubMed
Lo Sasso, A., Shah, M. and Frogner, B. (2010), ‘Health savings accounts and health care spending’, Health Services Research, 45(4): 1041–1060.CrossRefGoogle ScholarPubMed
Lo Sasso, A. T., Rice, T., Gabel, J. R. and Whitmore, H. (2004), ‘Tales from the new frontier: pioneers’ experiences with consumer-driven health care’, Health Services Research, 39(2): 1071–1090.CrossRefGoogle ScholarPubMed
Lueck, S. (2015), ‘New Republican proposal would leave millions uninsured or underinsured’. Center on Budget and Policy Priorities, http://www.cbpp.org/blog/new-republican-proposal-would-leave-millions-uninsured-or-underinsured [24 October 2015].Google Scholar
Mallya, G., Pollack, C. E. and Polsky, D. (2008), ‘Are primary care physicians ready to practice in a consumer-driven environment?’, American Journal of Managed Care, 14(10): 661–668.Google Scholar
Massaro, T. A. and Wong, Y.-N. (1995), ‘Positive experience with medical savings accounts in Singapore’, Health Affairs, 14(2): 267–272.CrossRefGoogle ScholarPubMed
McConnell, K. (2005), ‘What do health savings accounts mean for the emergency department?’, Annals of Emergency Medicine, 46(6): 536–540.CrossRefGoogle ScholarPubMed
McKee, M. and Busse, R. (2013), ‘Medical savings accounts: Singapore’s non-solution to healthcare costs’, BMJ, 347: f4797.CrossRefGoogle ScholarPubMed
McLeod, H. and McIntyre, D. (2008), ‘Medical savings accounts in South Africa’, Euro Observer, 10(4): 7–9.Google Scholar
Minicozzi, A. (2006), ‘Medical savings accounts: what story do the data tell?’, Health Affairs, 25(1): 256–267.CrossRefGoogle ScholarPubMed
Monheit, A. (2003), ‘Persistence in health expenditures in the short run: prevalence and consequences’, Medical Care, 41(7 Supplement): 53–64.CrossRefGoogle ScholarPubMed
Muhlestein, D. B., Wilks, C. E. and Richter, J. P. (2013), ‘Limited use of price and quality advertising among American hospitals’, Journal of Medical Internet Research, 15(8): e185.CrossRefGoogle ScholarPubMed
Newhouse, J. P., Insurance Experiment Group (1993), Free for All? Lessons from the RAND Health Insurance Experiment, Cambridge: Harvard University Press.Google Scholar
Nichols, L., Prescott, N. and Phua, K. (1997), ‘Medical savings accounts for developing countries’’, in G. Schieber (ed.), Innovations in Health Care Financing, Washington, DC: World Bank, 233–245.Google Scholar
Parente, S. T., Christianson, J. B. and Feldman, R. (2007), ‘Consumer-directed health plans and the chronically ill’, Disease Management and Health Outcomes, 15(4): 239–248.CrossRefGoogle Scholar
Parente, S. T., Feldman, R. and Chen, S. (2008), ‘Effects of a consumer driven health plan on pharmaceutical spending and utilization’, Health Services Research, 43(5): 1542–1556.CrossRefGoogle ScholarPubMed
Parente, S.T., Feldman, R. and Christianson, J.B. (2004a), Evaluation of the effect of a consumer-driven health plan on medical care expenditures and utilization’, Health Services Research, 39(4): 1189–1210.CrossRefGoogle ScholarPubMed
Parente, S. T., Feldman, R. and Christianson, J. B. (2004b), Employee choice of consumer-driven health insurance in a multiplan, multiproduct setting’, Health Services Research, 39(4): 1091–1112.CrossRefGoogle Scholar
Park, E. (2015), ‘Cassidy health plan allows more tax sheltering for well-to-do’. Center on Budget and Policy Priorities, http://www.cbpp.org/blog/cassidy-health-plan-allows-more-tax-sheltering-for-well-to-do [18 October 2015].Google Scholar
Park, E. and Biniek, J. (2015), ‘Republican Study Committee health plan would likely result in many more uninsured and fewer consumer protections’. Center on Budget and Policy Priorities, http://www.cbpp.org/research/health/republican-study-committee-health-plan-would-likely-result-in-many-more-uninsured [24 October 2015].Google Scholar
Pauly, M. V. and Goodman, J. C. (1995), ‘Tax credits for health insurance and medical savings accounts’, Health Affairs, 14(1): 126–139.CrossRefGoogle ScholarPubMed
Pei, Y. (2008), ‘The issue of keeping medical saving account with the social health insurance’, Population and Economics, 168(3): 65 (in Chinese).Google Scholar
Reed, M., Benedetti, N., Brand, R., Newhouse, J. P. and Hsu, J. (2009), ‘Perspectives from deductible plan enrolees: plan knowledge and anticipated care-seeking changes’, BMC Health Services Research, 9: 244.CrossRefGoogle Scholar
Reed, M., Graetz, I., Wang, H., Fung, V., Newhouse, J. P. and Hsu, J. (2012), ‘Consumer-directed health plans with health savings accounts: whose skin is in the game and how do costs affect care seeking?’, Medical Care, 50(7): 585–590.CrossRefGoogle ScholarPubMed
Reinhardt, U. E. (2006), ‘The pricing of US hospital services: chaos behind a veil of secrecy’, Health Affairs, 25(1): 57–69.CrossRefGoogle ScholarPubMed
Remler, D. K. and Glied, S. A. (2006), ‘How much more cost sharing will health savings accounts bring?’, Health Affairs, 25(4): 1070–1078.CrossRefGoogle ScholarPubMed
Robinson, J. C. (2005), ‘Health savings accounts – the ownership society in health care’, New England Journal of Medicine, 353(12): 1199–1202.CrossRefGoogle ScholarPubMed
Rowe, J. W., Brown-Stevenson, T., Downey, R. L. and Newhouse, J. P. (2008), ‘The effect of consumer-directed health plans on the use of preventive and chronic illness services’, Health Affairs, 27(1): 113–120.CrossRefGoogle ScholarPubMed
Sedjo, R. L. and Cox, E. R. (2009), ‘The influence of targeted education on medication persistence and generic substitution among consumer-directed health care enrolees’, Health Services Research, 44(6): 2079–2092.CrossRefGoogle Scholar
Sheng, S. and Hou, X. (2011), ‘Inequities and inefficiency in medical saving account-the findings from Guangdong, China’, Chinese Journal of Population Science, 5(1): 75 (in Chinese).Google Scholar
Sichuan News (2015), ‘New healthcare reform in Chengdu city-using medical saving account to pay for commercial health insurance (in Chinese), http://scnews.newssc.org/system/20150106/000526607.html [3 July 2015].Google Scholar
Singapore Ministry of Health (2013), ‘Healthcare financing sources’, http://www.moh.gov.sg/content/moh_web/home/pressRoom/Parliamentary_QA/2013/healthcare-financing-sources0.html [7 December 2013].Google Scholar
Stanton, M. W. and Rutherford, M. K. (2006), ‘The high concentration of U.S. health care expenditures’, Issue 19, AHRQ Pub No. 06-060. Rockville, MD: Agency for Healthcare Research and Quality: Research in Action.Google Scholar
Thomson, S., Võrk, A., Habicht, T., Rooväli, L., Evetovits, T. and Habicht, J. (2010), ‘Responding to the challenge of financial sustainability in Estonia’s health system’, World Health Organization, Regional Office for Europe, Copenhagen, 142pp.Google Scholar
Thorpe, K. E. (1995), ‘Medical savings accounts: design and policy issues’, Health Affairs, 14(3): 254–259.CrossRefGoogle Scholar
Tollen, L. A., Ross, M. N. and Poor, S. (2004), ‘Risk segmentation related to the offering of a consumer-directed health plan: a case study of Humana Inc’, Health Services Research, 39(4): 1167–1188.CrossRefGoogle Scholar
Wilson, A. R., Bargman, E. P., Pederson, D., Wilson, A., Garrett, N. A., Plocher, D. W. and Ailiff, P. L. (2008), ‘More preventive care, and fewer emergency room visits and prescription drugs—health care utilization in a consumer-driven health plan’, Benefits Quarterly, 24(1): 46–54.Google Scholar
Woolhandler, S. and Himmelstein, D. U. (2007), ‘Consumer-directed health care: except for the healthy and wealthy it’s unwise’, Journal of General Internal Medicine, 22(6): 879–881.CrossRefGoogle ScholarPubMed
Worstall, T. (2013), ‘Why not US healthcare? Because we want something much more free market than that’. Adam Smith Institute, http://www.adamsmith.org/blog/healthcare/why-not-us-healthcare-because-we-want-something-much-more-free-market-than-that/ [1 November 2015].Google Scholar
Xia, Y. (2014), ‘Medical saving account for urban employee insurance-is it worth keeping?’, Microeconomics, 4(1): 51 (in Chinese).Google Scholar
Xinhua News (2009), ‘Share the medical saving account with your family in Zhengjiang, Jiangsu http://news.xinhuanet.com/society/2009-06/04/content_11486920.htm [3 July 2015].Google Scholar
Xinhua News (2015), ‘Using the 323 billion surplus in medical saving account to pay for commercial health insurance (in Chinese), http://news.xinhuanet.com/fortune/2015-01/15/c_127388775.htm [3 July 2015].Google Scholar
Xue, X. and Zhao, M. (2007), ‘An economic analysis of the low efficiency of private medical savings account’, Chinese Health Economics, 26(9): 73 (in Chinese).Google Scholar
Yi, Y., Maynard, A., Liu, G., Xiong, X. and Lin, F. (2005), ‘Equity in health care financing: evaluation of the current urban employee health insurance reform in China’’, Journal of the Asia Pacific Economy, 10(4): 506–527.CrossRefGoogle Scholar
Yip, W. and Hsiao, W. (1997), ‘Medical savings accounts: lessons from China’, Health Affairs, 16(6): 244–251.CrossRefGoogle ScholarPubMed
Yip, W. and Hsiao, W. (2009), ‘Non-evidence-based policy: how effective is China’s new cooperative medical scheme in reducing medical impoverishment?’, Social Science & Medicine, 68(2): 201–209.CrossRefGoogle ScholarPubMed