Medical Savings Account balance and outpatient utilization : a multivariate analysis on the impact of the Medical Savings Account in China

Abstract

The objective of this study is to examine the impact of the Medical Savings Account (MSA) balance on outpatient utilization, and to evaluate whether the MSA can achieve its intended functions of "Cost-containment", "Savings for the future", and "Enabling for utilization" in China. A two-part model (logistic + OLS) is employed to estimate the effect of the MSA balance on (1) the probability of outpatient service usage and (2) the level of outpatient expenditure. This study shows that the MSA balance significantly affects the probability of outpatient usage as well as the incurred level of expenditure. For general cases, the relationship between the MSA balance and outpatient expenditure is U-shaped. Both income level and the presence of chronic conditions can affect the nonlinear balance-expenditure relationship. In general, the MSA has achieved its three intended functions of "Cost-containment", "Savings for the future", and "Enabling for utilization" for the majority of its enrollees, with the exception of certain special cases.