What savings?

July 22, 2002

This issue of CMAJ features an extensive discussion on one of the more interesting -- and hotly debated -- ideas for health care reform: Medical Savings Accounts (MSAs).

MSAs are an attempt to reduce health care costs by transferring responsibility for expenditures to patients while at the same time providing state-supported base amounts to cover some of the costs. In his review of the scant literature on the use of MSAs in publicly financed health care systems, Dr. Samuel Shortt concludes that current knowledge of their use is too limited to recommend them for the Canadian health care system.

In a related Research article, Evelyn Forget and colleagues state that MSAs would not lead to savings in health care spending, as some proponents suggest. They assessed costs incurred by individual Manitoba residents for all physician visits and admissions to hospital between 1997 and 1999 and used the data to calculate an average expenditure per person of $730 annually for the 3 years. The authors conclude that if the $730 threshold was used as the MSA entitlement in the province, total government spending on health care would increase by $505 million.

In his commentary on the use of MSAs in Canada, Jeremiah Hurley agrees with Shortt that MSAs are unlikely to have the desired effects of reducing health care spending while maintaining access to services for all Canadians. However, while agreeing that data to bolster the case for using MSAs in Canada may be lacking, David Gratzer points out there is no "perfect health care system that Canada can simply copy." He suggests the time has come to at least experiment with MSAs in order to learn more.
Medical Savings Accounts: Will they reduce costs? -- E.L. Forget, R. Deber, L.L. Roos

It's time to consider Medical Savings Accounts -- D. Gratzer

Medical Savings Accounts will not advance Canadian health care objectives -- J. Hurley

Medical Savings Accounts in publicly funded health care systems: enthusiasm versus evidence -- S.E.D. Shortt

Canadian Medical Association Journal

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