Commentary-Current MSA Theory: Well-Meaning but Futile

• Published in: Health services research 2004-08, Vol.39 (4p2), p.1119-1122
• Main Author: Halvorson, George C.
• Format: Article
• Language: English
• Subjects: Company distribution practices; Consumer Behavior; Consumer-Driven Plans: What's Offered? Who Chooses?; Cost control; Cost Savings; Deductibles and Coinsurance; Distribution; Evaluation; Health Benefit Plans, Employee - economics; Health Benefit Plans, Employee - organization & administration; Health care costs; Health care expenditures; Health Services Accessibility; Health Services Needs and Demand; Health services utilization; Humans; Insurance Selection Bias; Managed Care Programs - economics; Managed Care Programs - utilization; Medical care, Cost of; Medical savings accounts; Medical Savings Accounts - economics; Medical Savings Accounts - utilization; Patients; United States
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/j.1475-6773.2004.00277.x

Medical savings accounts (MSAs), in their current form, generally represent an increasingly visible and well-meaning, but potentially futile and sometimes counterproductive, attempt to include consumers in the major costs of care in any meaningful way. One key part of the underlying theory is valid. Advocates of MSAs say that if consumers lose their current financial insulation from the direct costs of care, then those consumers will tend to make different decisions at some level about the nature and scope of their care. That is probably true. The problem is that the MSA benefit packages, as they are currently designed, tend to ignore the practical reality of what health care actually costs today as well as the reality of who actually uses that care. The typical MSA benefit package is irrelevant to expensive patients; irrelevant to cheap patients; and a potentially painful disincentive for chronic care patients. Despite its undoubted good intentions, that is not really a good care-based approach.