Have individual medical savings accounts accumulated meaningful balances after 10 years of enrolment? Empirical evidence from China.

Objectives To examine whether medical savings accounts in China have achieved the intended goal of promoting individual savings for medical care. Method Longitudinal data were obtained from one of the first Chinese cities that implemented medical savings accounts. The sample includes 246,681 enrolees with participation of at least 10 years by the end of 2010. We conducted descriptive analyses of medical savings account balances and a series of multivariate logistic analyses of risk factors for having low medical savings account accumulation. Results Medical savings account accumulation was low, with 41% of the enrolees having a balance below the average cost per outpatient visit, and the proportion increased to 54% and 58% when the deductible for inpatient care at secondary and tertiary hospitals was used as the threshold, respectively. Factors associated with having low medical savings account accumulation include female, old age, below high school education, retired and having a lower salary. Conclusion Medical savings accounts have not achieved the intended goal of encouraging personal savings for medical care. Given the low medical savings account accumulation, China's decision-makers need to adjust policies, especially during the current healthcare reform.