Byrne Joseph M, Rathwell Thomas
IWK Health Centre, Faculty of Medicine, Dalhousie University, 5850/5980 University Avenue, PO Box 3070, Halifax, NS, Canada B3J 3G9.
Health Policy. 2005 Jun;72(3):367-79. doi: 10.1016/j.healthpol.2004.09.013. Epub 2004 Dec 8.
The publicly funded health system in Canada, almost since inception, has been the focus of numerous critiques, matched only by the solutions offered, and the secondary problems generated. One of the proposed solutions is the use of medical savings accounts (MSAs). It is reasoned that MSAs will make Canadians more accountable for the health services they utilize, yield cost containment, and potential savings. However, before a nation-wide, public MSA can be considered further, there is need to reconcile the following: (a) empirical evidence in support of MSAs that is not as compelling as some of its proponents argue; (b) the scale and complexity of a MSA if integrated into a publicly funded, nation-wide health system in a country the size of Canada; (c) whether the cost to formulate, implement, and operate a nation-wide Canadian MSA would yield the net gains to warrant such an expenditure; (d) the fact that implementation of a nation-wide MSA potentially may contravene the Canada Health Act.
加拿大的公共资助医疗体系自成立以来几乎一直是众多批评的焦点,与之相匹配的只有所提出的解决方案以及由此产生的次生问题。提议的解决方案之一是使用医疗储蓄账户(MSA)。理由是医疗储蓄账户将使加拿大人对他们所使用的医疗服务更加负责,实现成本控制并可能节省开支。然而,在进一步考虑全国性的公共医疗储蓄账户之前,需要协调以下几点:(a)支持医疗储蓄账户的实证证据并不像其一些支持者所主张的那样有说服力;(b)如果将医疗储蓄账户整合到加拿大这样规模国家的公共资助全国性医疗体系中,其规模和复杂性;(c)制定、实施和运营全国性加拿大医疗储蓄账户的成本是否会产生足以证明这种支出合理的净收益;(d)实施全国性医疗储蓄账户可能会违反《加拿大健康法》这一事实。