title: Medical savings accounts: assessing their impact on efficiency, equity and financial protection in health care.
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.
authors.affiliation: 1LSE Health,London School of Economics and Political Science,London,UK.
authors.forename: Olivier J
authors.initials: OJ
authors.lastname: Wouters
authors.affiliation: 1LSE Health,London School of Economics and Political Science,London,UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cylus
authors.affiliation: 1LSE Health,London School of Economics and Political Science,London,UK.
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.affiliation: 1LSE Health,London School of Economics and Political Science,London,UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Thomson
authors.affiliation: 2European Observatory on Health Systems and Policies,London,UK.
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
mesh_terms: D002681:China; D003669:Deductibles and Coinsurance / Q000706:statistics & numerical data; D005382:Financing, Personal; D017048:Health Care Costs / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data; D006291:Health Policy / Q000191:economics*; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D020402:Medical Savings Accounts / Q000191:economics*; D012846:Singapore; D013019:South Africa; D014481:United States