Arrangements of medical savings accounts and equity in access to health care : assessing two MSA programs in China

Abstract

Social security has become an important topic not only for developed nations, but also developing nations because of the fast growing health expenditures and high risks modern society bears considering the outbreak of some contagious disease that spreads rapidly and widely. In the recent decade, China government pushes Medical Savings Account (MSA) health insurance reform in entire urban areas. For a city-based health insurance plan, considerable variations in the benefit coverage and cost-sharing between individual accounts and social insurance fund could be found in different China cities. The aim of the study is to examine how the adoption of some MSA arrangement influences insured's access and equity in access to health care. Using primary data from the controlled group informants in Zhenjiang and Hefei, this thesis empirically assesses the extent to which two typical MSA arrangements separately achieves its stated goals. Only non-financial access is considered here based on the probability of visiting. Our findings show that insured on higher position have more chance to use diagnosis service. Insured that report better health status have more chance to use emergency service. Under Tongdao MSA program, insured tend to use more emergency service than that under Bankuai program. And different MSA arrangements do have effect on the relationship between insured's education and their probability of emergency service visiting. Under Bankuai MSA program, access to emergency service is more equitable across education subgroup. We also could see the tendencies that Bankuai MSA arrangement shows more equitable access to health care than the Tongdao MSA arrangement in general. While in some instance, especially for diagnosis using, the insured under Tongdao MSA arrangement report more equitable access pattern. Although it indicates that Tongdao MSA arrangement helps to improve access to outpatient service, emergency service, and inpatient service, it may induce overuse and even moral hazard transferring outpatient service to inpatient service based on the findings of equity improvement.