Have individual medical savings accounts accumulated meaningful balances after 10 years of enrolment? Empirical evidence from China

Objectives To examine whether medical savings accounts in China have achieved the intended goal of promoting individual savings for medical care. Method Longitudinal data were obtained from one of the first Chinese cities that implemented medical savings accounts. The sample includes 246,681 enrolees with participation of at least 10 years by the end of 2010. We conducted descriptive analyses of medical savings account balances and a series of multivariate logistic analyses of risk factors for having low medical savings account accumulation. Results Medical savings account accumulation was low, with 41% of the enrolees having a balance below the average cost per outpatient visit, and the proportion increased to 54% and 58% when the deductible for inpatient care at secondary and tertiary hospitals was used as the threshold, respectively. Factors associated with having low medical savings account accumulation include female, old age, below high school education, retired and having a lower salary. Conclusion Medical savings accounts have not achieved the intended goal of encouraging personal savings for medical care. Given the low medical savings account accumulation, China’s decision-makers need to adjust policies, especially during the current healthcare reform.

COST CONTAINMENT AND ACCESS TO CARE: THE SHANGHAI HEALTH CARE FINANCING MODEL

The medical savings account (MSA) model of health care financing is viewed as a health care cost containment strategy. Yet, health care expenditure in Shanghai has increased sharply since the adoption of the MSA system. This paper looks into the health care reforms in Shanghai, especially since the introduction of the MSA scheme. From the Labor Insurance Scheme and Government Insurance Scheme to the Medical Savings Account scheme, ordinary Shanghai residents have not benefited from the most recent health care reforms. They have found medical care much less affordable. Disparity in access to health care access has become more evident than ever. Meanwhile, health care cost has increased sharply. China has benefited from an emphasis on prevention and primary care, but the government's recent policies give a high priority to catastrophic disease. This is not a cost-effective approach. Shanghai's health care system needs to break socioeconomic class boundaries if it is to construct a harmonious society. Shanghai's decision makers and various stakeholders have the resources and wisdom to face the challenge.