Deber Raisa B, Forget Evelyn L, Roos Leslie L
Department of Health Policy, Management and Evaluation, University of Toronto, 12 Queens Park Crescent West, 2nd Floor, Toronto, Ont., Canada M5S 1A8.
Health Policy. 2004 Oct;70(1):49-66. doi: 10.1016/j.healthpol.2004.01.010.
Medical savings accounts (MSAs) and similar approaches based on flowing reimbursements through individuals/consumers rather than providers are unsuited for systems with universal coverage. Data from Manitoba, Canada reveal that, because expenditures for physician and hospital services are highly skewed in all age groups, MSAs would substantially increase both public expenditures and out-of-pocket costs for the most ill. The empirical distribution of health expenditures limits the potential impact of many current 'demand-based' approaches to cost control. Because most of the population is relatively healthy and uses few hospital and physician services, inducing the general population to spend less will not yield substantial savings.
医疗储蓄账户（MSA）以及类似的基于让个人/消费者而非医疗服务提供者获得报销的方法，并不适用于全民覆盖的医疗体系。加拿大曼尼托巴省的数据显示，由于各年龄组的医生和医院服务支出严重不均，医疗储蓄账户会大幅增加最需要治疗人群的公共支出和自付费用。医疗支出的实证分布限制了当前许多“基于需求”的成本控制方法的潜在影响。由于大多数人口相对健康，很少使用医院和医生服务，促使普通人群减少支出不会带来可观的节省。
