Medical Savings Accounts Research Articles

СОЦИАЛЬНЫЕ ФИНАНСОВЫЕ ТЕХНОЛОГИИ РАЗВИТИЯ ЗДРАВООХРАНЕНИЯ НА ОСНОВЕ МЕДИЦИНСКИХ НАКОПИТЕЛЬНЫХ СЧЕТОВ

The article details the transition, starting in 2023, from the existing financing system to medical savings accounts (MSA). It is shown that already in 2023, for all categories of citizens (employed, low-wage, non-working) income from the Ministry of Taxation exceeds standard (within the framework of compulsory health insurance) expenses. The surplus of funds for the Ministry of Taxes in the first year (2023) implementation amounted to 241,6 billion rubles, in the fifth year 4,9 trillion rubles, and in the twentieth 105,3 trillion rubles. These funds, placed by banks (Sberbank and VTB) in the form of loans, will provide the Russian economy with huge, long-term and cheap financial resources. It is shown that in about twenty years, citizens’ MSA will accumulate a non-reducible balance sufficient for 20 years of survival after retirement, and employers, instead of 5,1% of workers’ wages, will be able to deduct only 1% for co-financing of low-paid and unemployed citizens, which will significantly reduce production costs at all Russian enterprises. Since funds for the MSA can only be spent on medical care, the surplus of funds will provide the opportunity for Russian citizens to receive additional medical services, including high-tech ones, as well as receive medicines, and medical organizations will receive a huge additional source of funding.

АНАЛИЗ СИСТЕМЫ ФИНАНСИРОВАНИЯ ЗДРАВООХРАНЕНИЯ КИТАЯ

The article analyzes the development of the health insurance system of the Chinese population since 1950. The paper shows that China has been using medical savings accounts (MSA) as a key element of the urban healthcare financing system since 1994. In addition to the specifics of the introduction of MSA in China, it reveals the benefits of MSA for working citizens, business and the health of Chinese citizens.

МЕДИЦИНСКИЕ НАКОПИТЕЛЬНЫЕ СЧЕТА КАК ПЕРСПЕКТИВНЫЙ ИСТОЧНИК ФИНАНСИРОВАНИЯ ЗДРАВООХРАНЕНИЯ ГВИНЕЙСКОЙ РЕСПУБЛИКЕ

The paper analyzes the experience of using medical savings accounts (MSA) as a source of financing for healthcare in South Africa. The possibility and expediency of introducing a new breakthrough healthcare financing system of the Republic of Guinea based on the MSA is substantiated and proved. The principles of organizing the transition of citizens of the Republic of Guinea to the MSA are shown. A scheme for financing the health care of the Republic of Guinea based on the MSA has been developed. The simulation of the accumulation of financial resources on the MSA of working citizens of Guinea and the non-working population: children and pensioners has been carried out. It is proved that for all categories of citizens of the republic, the funds received and accumulated on their personal MSA will be enough to cover the costs of medical care at existing fixed rates.

Medical Savings Accounts: Implications on Healthcare Expenditure, Efficiency, Equity, and Financial Protection

Medical Savings Accounts: Implications on Healthcare Expenditure, Efficiency, Equity, and Financial Protection

ЭКОНОМЕТРИЧЕСКАЯ МОДЕЛЬ РАЗВИТИЯ РЕГИОНОВ НА ОСНОВЕ МЕДИЦИНСКИХ НАКОПИТЕЛЬНЫХ СЧЕТОВ

An econometric model of the development of the regions of the Russian Federation based on medical savings accounts (MSA) has been developed. The presence of the phenomenon of multicollinearity in the model based on the correlation matrix is verified and its statistical significance is evaluated according to the Fisher criterion. The practical implementation of the developed econometric model is made on the example of the Southern Federal District and separately the Rostov region. It is shown that as a result of the practical application of the developed econometric model, the complex indicator of the level of investment attractiveness of the Rostov region increases from 1.872 to 2.084, i.e. by 11.3%, which moves it in the rating of investment attractiveness according to the evaluation methodology of the rating agency Expert-RA from ninth to sixth place. As a result of the practical application of the developed econometric model and the de-termination of the level of investment attractiveness based on the MSA, the Krasnodar region received the highest rating for the Southern Federal District, the level of its investment attractiveness according to the method of econometric modeling based on the MSA was 2.37, the Republic of Kalmykia received the lowest rating for this indicator, the investment attractiveness of this region, calculated according to the developed methodology, was 0.183. It is concluded that the highest ratings from the point of view of investment attrac-tiveness in modeling are obtained by regions that invest in the development of the MSA system, since factors that depend on the MSA have a positive impact on the assessment of the level of development of regions.

ЭКОНОМИЧЕСКИЙ ЭФФЕКТ ОТ ИСПОЛЬЗОВАНИЯ МЕДИЦИНСКИХ НАКОПИТЕЛЬНЫХ СЧЕТОВ ВМЕСТО СУЩЕСТВУЮЩЕЙ СИСТЕМЫ ФИНАНСИРОВАНИЯ ЗДРАВООХРАНЕНИЯ

The article simulates the accumulation of financial resources on medical savings accounts (MSA) of working and non-working citizens of the Russian Federation for the period from 1994 to 2020 in the case of using in practice the system of compulsory medical insurance of citizens based on MSA instead of the existing system of financing domestic health care. Described and illustrated by calculations of all the elements of economic effect from the use of MSA.

ОРГАНИЗАЦИЯ ПЕРЕХОДА ГРАЖДАН СВЕРДЛОВСКОЙ ОБЛАСТИ НА МЕДИЦИНСКИЕ НАКОПИТЕЛЬНЫЕ СЧЕТА

The paper shows the principles of organizing the transition of Sverdlovsk region citizens to medical savings accounts (MSA). A scheme for financing health care in the Sverdlovsk region based on MSA has been developed. A simulation of the accumulation of financial resources on the MSA of all categories of citizens of the Sverdlovsk region was performed. It is proved that for all categories of Sverdlovsk region citizens, including citizens, have chronic diseases, the funds accumulated on their personal MSA, will be sufficient to cover the costs of medical care.

ОРГАНИЗАЦИЯ ПЕРЕХОДА ГРАЖДАН РОССИИ НА МЕДИЦИНСКИЕ НАКОПИТЕЛЬНЫЕ СЧЕТА

The paper shows the principles of organizing the transition of Russian citizens to medical savings accounts (MSA). A simulation of the accumulation of financial resources on the MSA of all categories of citizens of the Russian Federation was performed, taking into account the need for a significant increase in the salary of medical personnel, namely: in accordance with the “may” Decrees of 2012, V. V. Putin, to bring the salary of doctors to a level twice higher than the average for the region by 2018. It is proved that for all categories of Russian citizens, including citizens, have chronic diseases, the funds accumulated on their personal MSA, will be sufficient to cover the costs of medical care given the salaries of medical personnel established in the “may” decrees of the President of the Russian Federation.

Framing Flexible Spending Accounts: A Large-Scale Field Experiment on Communicating the Return on Medical Savings Accounts.

Tax-preferred health savings devices such as Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) offer employees potentially valuable financial instruments for directing pre-tax earnings to eligible medical expenses. Despite their increasing popularity as an employee benefit, however, there is little causal evidence around individual demand for these accounts. This paper seeks to address this gap in the literature, reporting on a randomized controlled field experiment conducted with over 11,000U. S federal employees in 2017 in order to evaluate the effectiveness of targeted messages designed to increase FSA contributions. Our results suggest that the provision of basic information about FSAs delivered via an emailed employee newsletter did not affect the likelihood of contribution or the contribution level. The addition of statements about the absolute returns or relative returns offered by the accounts similarly had no significant effects, and these null effects are observed despite relatively high email open rates. We discuss explanations for the null results and the policy implications of findings from what appears to be the first health economics experiment analyzing tax incentives around health care savings.

Home Healthcare and Hospice: A Pacific Islands Perspective.

The Pacific Islands Geriatric Education Center of the University of Hawaii conducted situational assessments of caregivers, older adults, and healthcare professionals in the Republic of Palau. The findings revealed an urgent need for a solution to the identified crisis of an aging population, increasing chronic diseases and their corresponding impact on caregivers and society. In 2010, the National Healthcare Financing Act was signed into law, becoming Palau's first step in helping residents and workers in Palau pay for medical expenses. This program is referred to as the Health Care Fund and consists of two parts: National Health Insurance and Medical Savings Account. Advocacy and promotion of home healthcare services in Palau was facilitated by the Pacific Islands Geriatric Education Center. Because of these efforts, systems changed to establish home healthcare services and expand the Health Care Fund with a proposed Home Health Insurance Benefit from the National Health Insurance. This is a huge leap forward to improve access to care for older adults and homebound in Palau.

Association Between Employee Earnings and Consumer-Directed Health Plan Choices

INTRODUCTIONThis study explores the relationship between employee earnings and choice of a consumer-directed health plan (CDI IP) verses a managed care plan in an employer-sponsored insurance (ESI) program. The increased variation in healthcare insurance plan designs over the past decade has led to a greater need to understand the impact of consumer choice with respect to health insurance plans. CDHPs are associated with plan designs that incorporate high deductibles and greater cost sharing. Researchers have consistently found that employee earnings are positively associated with CDHP enrollment (Barry, Cullen, Galusha, Slade, & Busch, 2008; Buntin et al., 2006; Cohen & Martinez, 2009; Dicken, 2006; lx) Sasso, Rice, Gabel, & Whitmore, 2004; Parente, Feldman, & Christianson, 2004a, 2004b, 2008; Tollen, Ross, & Poor, 2004). However, it is unclear if variations in CDHP choice are discernable at all levels of employee earnings.CDHPs emerged in the early 2000s as an alternative healthcare insurance plan design intended to slow the persistent cost increases of ESI, which have nearly doubled since the late 1990s (Claxton et al., 2014). From 2006 to 2014, CDHP enrollment for ESI plans has grown from 4% to 20%, with 27% of employers offering at least one CDHP plan (Kaiser Family Foundation, 2013). Through high deductibles and greater upfront cost sharing by enrollees, CDHPs encourage consumer engagement in healthcare decision making to presumably lower discretionary healthcare use and facilitate better healthcare choices, thus reducing ESI costs or slowing their rate of growth.Health Reimbursement Arrangements and Health Savings Account-Eligible PlansHealth reimbursement arrangements (I IRAs) and health savings account (1ISA)-eligible high-deductible plans have become the two primary CDHP models. From the perspective of enrollees, HRA designs are similar to HSAs relative to the financing arrangement or savings account, but unlike I IS As, I IRA funds are not owned by employees and do not require coupling with a highdeductible plan (Bloche, 2006).HRAs emerged in 2001 and were modeled on the 1996 medical savings account (MSA) pilot program that was part of the Health Insurance Portability and Accountability Act (Parente et al., 2008). Although I IRAs can be offered as a stand-alone, defined-contribution vehicle, they usually are coupled with a high-deductible plan. Employers finance the HRA to offset enrollee out-of-pocket costs; however, a gap or donut hole in coverage remains. The donut-hole phase-the employee's high-deductible period-takes place when I IRA funds are exhausted and before plan indemnity begins.HSAs were established as part of Medicare legislation passed in 2003 (Parente et al., 2008). HSAs introduced employee funding and ownership of the medical spending account, which is portable, may contain investment characteristics, and allows greater employee control over the level of funding to subsidize healthcare costs. The level of employee funding, and annual accrual of such funds, determines enrollees' exposure to out-ofpocket costs during the high-deductible period.Association Between CDHPs and Enrollee EarningsResearch findings show a positive association between CDHPs and enrollee earnings, which may suggest favorable selection (Barry et al., 2008; Buntin et al., 2006; Cohen & Martinez, 2009; Dicken, 2006; Id Sasso et al., 2004; Parente et al., 2004a, 2004b, 2008; Tollen et al., 2004). Individuals in higher socioeconomic groups are generally healthier and require fewer healthcare services than do those in lower socioeconomic groups (Bloche, 2007; Hughes-Cromwick, Root, & Reohrig, 2007; Marquis et al., 2006). Alternatively, households with higher earnings may have a higher risk tolerance or premium cost elasticity, meaning they are less willing to pay higher premiums for lower cost-sharing risk (Callan & Johnson, 2002; Parente et al. …

China's medical savings accounts: an analysis of the price elasticity of demand for health care.

Although medical savings accounts (MSAs) have drawn intensive attention across the world for their potential in cost control, there is limited evidence of their impact on the demand for health care. This paper is intended to fill that gap. First, we built up a dynamic model of a consumer's problem of utility maximization in the presence of a nonlinear price schedule embedded in an MSA. Second, the model was implemented using data from a 2-year MSA pilot program in China. The estimated price elasticity under MSAs was between -0.42 and -0.58, i.e., higher than that reported in the literature. The relatively high price elasticity suggests that MSAs as an insurance feature may help control costs. However, the long-term effect of MSAs on health costs is subject to further analysis.

Premium Collection and the Problem of Voluntary Enrolment in China's New Rural Cooperative Medical System

In late 2002, the Chinese government launched an initiative to extend the coverage of health insurance in rural China with the New Rural Cooperative Medical System (NRCMS). It covered all of rural China by 2008 and is being continuously adapted and developed. This study explores two conflicting goals in the policy design: universal coverage and voluntary enrolment. Local governments often faced the problem that only insufficient numbers of villagers were enrolling voluntarily. They developed different strategies to cope with it: Complementary outpatient reimbursement via medical savings accounts (MSAs) effectively transferred villagers’ premiums back to them, thus making the NRCMS more attractive. Adapting the premium-collection process to the local context or utilising collusive practices allowed them to pay premiums on behalf of the villagers from the insurance funds. These strategies undermine the effectiveness of the NRCMS as a risk-pooling mechanism, facilitate latent coverage gaps and turn it into a tax-funded service.

Medical Savings Account balance and outpatient utilization: Evidence from Guangzhou, China

Medical Savings Account (MSA) is a financing instrument designed to reduce consumer-side moral hazards. The Urban Employee Basic Medical Insurance (UEBMI) scheme in China has an MSA component in addition to a Social Risk-pooling Fund. This study examines the association between MSA balance and outpatient utilization in Guangzhou, China, and determines MSA's impact on utilization under different circumstances. It also seeks to ascertain whether MSA has achieved its intended functions of “Cost-containment”, “Saving for the future” and “Enabling utilization”. The first group of 114,657 MSA account-holders, including both employees and retirees, who consistently insured with UEBMI from 2002 to 2007, are selected for this study. A two-part model is employed to estimate the effect of the MSA balance on the probability of outpatient services utilization and on the level of outpatient expenditure. Results show that MSA balance is significantly associated with the likelihood of using outpatient services as well as the level of outpatient expenditure. The association is a non-linear U-shaped relationship for working individuals, and an inverted U-shaped relationship for the retirees. The observed U-shaped relationship for working individuals implies that at lower MSA balance levels, a negative balance–expenditure relation exits, while at higher MSA balance levels, the relationship is positive – suggesting possible improper utilization when MSA balance reaches high levels. Setting a maximum MSA balance limit and/or allowing enrollees to use MSA funds to purchase private insurance appears to be desirable. The observed inverted U-shaped relationship for retirees suggests that many retirees have to spend whatever funds they have in their MSA for outpatient care, but the less healthy individuals are able to shift the spending to inpatient care which is mainly financed by the Social Risk-pooling Fund. The results of this study also affirm the usefulness of MSA in performing its intended functions.

Discounting of Medical Savings Accounts

Medical savings accounts (MSAs), personal medical accounts that are restricted for health-care consumption only, have been widely adopted to cushion individuals against the financial risk due to il...

ESTIMATION OF INITIAL MEDICAL SAVINGS ACCOUNT BALANCE IN RELATION TO PERSONAL HEALTH CARE EXPENSES IN POLAND

The purpose of this paper is to analyze Medical Savings Accounts as an instrument used to finance private health care expenditure incurred by individuals in Poland. An Medical Savings Account (MSA) represents a mechanism of health care financing, which relies on the accumulation of personal savings to cover the costs of health care services at the time of consumption. The paper focuses on voluntary MSAs, which from an individual’s perspective can be considered as a tool for financing additional out-of-pocket medical expenses, especially after retirement. The concept and specific characteristics of an MSA and a financial product combining the Medical Savings Account with insurance against catastrophic health care costs are presented here. Next, with the use of actuarial methods, a model is proposed in order to estimate the amount of initial MSA balance, which representsa single payment made to this account to cover future health care costs without additional contributions. In the analysis the discounted value of health care expenses of an MSA holder is estimated depending on expected health care expenses, assumed interest rate and mortality rates. The results of the conducted simulation analysis can be useful in practice, especially in the context of accumulation of savings to cover private medical expenses incurred by retirees, which if are funded on an ongoing basis can result in a significant burden for retirees’ household budgets.

The Demand for Alternative Forms of Financing Universal Health Care in Canada: A Literature Review

<div class="page" title="Page 32"><div class="layoutArea"><div class="column"><p><span>The discourse surrounding the unsustainability of financing universal health care in Canada has led many stakeholders to evaluate the current system in or- der to consider alternative forms of funding. Several health care financing mod- els have been suggested and include Medical Savings Accounts (MSAs), in- creased taxation and targeting policy to control specific cost drivers such as price inflation of physician and hospital services. This paper targets health care pro- fessionals, researchers and policy makers and calls for more awareness in evalu- ating public health reform initiatives for alternative measures of financing Uni- versal Health Care. Public reform must be critically considered in order to im- prove the cost and delivery of health care services since private methods ulti- mately impede on individual and population determinants of health. Discussed here are alternative financing strategies with an evaluation of benefits, limita- </span><span>tions, and future recommendations for Canada’s health care system. </span></p></div></div></div>

Problems and the Potential Direction of Reforms for the Current Individual Medical Savings Accounts in the Chinese Health Care System

Individual health savings accounts are an important part of the current basic medical insurance system for urban workers in China. Since 1998 when the system of personal medical insurance accounts was first implemented, there has been considerable controversy over its function and significance within different social communities. This paper analyzes the main problems in the practical implementation of individual medical insurance accounts and discusses the social and cultural foundations for the establishment of family health savings accounts from the perspective of Chinese Confucian familism. Accordingly, it addresses the direction of the reform and the development of the current system of individual health insurance accounts in China.

Building Social and Economic Capital: The Family and Medical Savings Accounts

Despite the well-documented social, economic, and adaptive advantages for young children, adolescents, and adults, the traditional family in the West is in decline. A growing percentage of men and women choose not to be bound by the traditional moral and social expectations of marriage and family life. Adults are much more likely than in the past to live as sexually active singles, with a concomitant increase in forms of social isolation as well as in the number of children born outside of marriage. These social shifts are also connected to public policies that provide incentives for individuals to exit the family, leaving behind its social, capital, and economic resources. The individualistic character of the social-democratic egalitarian ideology that underlies the current dominant approaches to health care financing in Western Europe and much of North America, for example, is associated with a decline in family stability. Welfare entitlements, including state-based health care, have made it easier to exit the family, undermining the centrality of the family's core human relationships. This essay argues for the importance of recognizing the cardinal role and reality of the family and for the importance of family-based health care savings accounts for preserving family integrity, while also providing for sustainable long-term health care reform.

Medical Savings Account: Implications for consumer choice, individual responsibility and efficiency

Medical Savings Account: Implications for consumer choice, individual responsibility and efficiency