Keeler E B, Malkin J D, Goldman D P, Buchanan J L
Health Sciences Program, RAND, Santa Monica, CA 90407-2138, USA.
JAMA. 1996 Jun 5;275(21):1666-71.
To understand how medical savings account (MSA) legislation for the nonelderly would affect health care costs.
Economic policy evaluation based on the RAND Health Expenditures Simulation Model.
National probability sample of nonelderly noninstitutionalized households.
Persons in 23 157 sampled households from the 1993 Current Population Survey.
Medical savings account legislation would allow all Americans who are covered only by a catastrophic health care plan to set up a tax-exempt account that they can use to pay medical bills not covered by their health insurance. The interventions we evaluate differ in the deductibles of the catastrophic plan and in whether the employee or employer funds the MSA.
Changes in national health expenditures and net societal benefits of health care.
If all insured nonelderly Americans switched to MSAs, their health care expenditures would decline by between 0% and 13%, depending on how the MSAs are designed. However, not all nonelderly Americans would choose MSAs; taking into account selection patterns, health spending would change by + 1% to -2%.
Medical savings account legislation would have little impact on health care costs of Americans with employer-provided insurance. However, depending on the size of the catastrophic limit, waste from the excessive use of generously insured care could be reduced, and MSAs would be attractive to both sick and healthy people.
了解针对非老年人的医疗储蓄账户（MSA）立法将如何影响医疗保健成本。
基于兰德医疗支出模拟模型的经济政策评估。
非老年人非机构化家庭的全国概率样本。
来自1993年当前人口调查的23157个抽样家庭中的人员。
医疗储蓄账户立法将允许所有仅参加灾难性医疗保险计划的美国人设立一个免税账户，用于支付其医疗保险未涵盖的医疗费用。我们评估的干预措施在灾难性计划的免赔额以及员工或雇主为医疗储蓄账户提供资金方面存在差异。
国家医疗支出的变化以及医疗保健的净社会效益。
如果所有参保的非老年人美国人都转而使用医疗储蓄账户，其医疗保健支出将下降0%至13%，具体取决于医疗储蓄账户的设计方式。然而，并非所有非老年人美国人都会选择医疗储蓄账户；考虑到选择模式，医疗支出将变化+1%至-2%。
医疗储蓄账户立法对有雇主提供保险的美国人的医疗保健成本影响不大。然而，根据灾难性限额的大小，过度使用高额保险护理造成的浪费可能会减少，并且医疗储蓄账户对患病和健康的人都有吸引力。
