Impact Of Medical Savings Accounts On Medical Expenditure

The Urban Medical Insurance reform in China was initiated in the 1990's, which combined with individual Medical Savings Accounts (MSA) and Social Pooling Accounts (SPA). It has several characteristics: high socialization degree, wide coverage, joint premium contributions by employers and employees, and some cost sharing mechanisms. Most scholars believe that medical insurance, as a third-party payment, is an important reason for the excessive growth of medical costs in modern society. Under this third-party payment mechanism, neither patients nor doctors are sensitive to prices and as a result escalates medical costs. Therefore, how to control the medical costs of medical insurance from both supply-side and demand-side has always been a hot research.As one of the first pilot cities, Zhenjiang City adjusted the medical insurance policy for several times and gradually formed a management of "Channel–type‖. But Up to now, there have been quite a few empirical studies on how the "Channel-type" management style and medical insurance policy related to MSAs effect the medical expenditureTo examine whether and how the MSA of the basic medical insurance system under a―Channel-type‖management affects the medical expenditure of workers with different socio-economic characteristics, so as to provide a scientific foundation for the policy improving of the medical insurance and the deepen reform of health system.Using a combination of quantitative and qualitative methods for the collection of "channel-style" medical insurance policy and information of the whole sample; quantifying the relationship between the MSAs and medical expenditure through regression analysis; applying econometrics methods such as fixed effect mode on a panel data, Instrumental Variable to deal with the endogenous variables, and the Logit model to analyze the binary dependent variables , as well as the test methods such as the Hausman test, and correction of first order autoregressive process.The main findings are the following:(1) Increased amount of MSAs would augment medical expenditure paid by MSAs, and decrease medical expenditure under the deductible line, the expenditure payed by SPA fund, the expenditure payed by medical insurance funds and the annual total medical expenditure. (2) Decreasing the proportion of fund into MSAs would reduce medical expenditure paid by MSAs. (3) Increasing the base payment would reduce medical expenditure in all the three stages. (4) Raising the deductible line would reduce medical expenditures from MSAs, expenditures below the deductible line and the co-ordination expenditure. (5) It was easier for retirees to enter the co-ordination, but the cost above co-ordinate of in-service personnel was higher.Some policy implications are discussed at the end of the dissertation based on our research results.