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Emmett B. Keeler, PhD; Jesse D. Malkin; Dana P. Goldman, PhD; Joan L. Buchanan, PhD

JAMA. 1996;275(21):1666-1671.

Abstract
Objective.
—To understand how medical savings account (MSA) legislation for the nonelderly would affect health care costs.

Design.
—Economic policy evaluation based on the RAND Health Expenditures Simulation Model.

Setting.
—National probability sample of nonelderly noninstitutionalized households.

Participants.
—Persons in 23157 sampled households from the 1993 Current Population Survey.

Interventions.
—Medical savings account legislation would allow all Americans who are covered only by a catastrophic health care plan to set up a tax-exempt account that they can use to pay medical bills not covered by their health insurance. The interventions we evaluate differ in the deductibles of the catastrophic plan and in whether the employee or employer funds the MSA.

Main Outcome Measures.
—Changes in national health expenditures and net societal benefits of health care.

Results.
—If all insured nonelderly Americans switched to MSAs, their health care expenditures would decline by between 0% and 13%, depending on how the MSAs are designed. However, not all nonelderly Americans would choose MSAs; taking into account selection patterns, health spending would change by +1% to -2%.

Conclusions.
—Medical savings account legislation would have little impact on health care costs of Americans with employer-provided insurance. However, depending on the size of the catastrophic limit, waste from the excessive use of generously insured care could be reduced, and MSAs would be attractive to both sick and healthy people.

(JAMA. 1996;275:1666-1671)

Author Affiliations
From the Health Sciences Program (Drs Keeler, Goldman, and Buchanan) and the RAND Graduate School (Mr Malkin), RAND, Santa Monica, Calif.

Footnotes
Corresponding author: Emmett Keeler, PhD, RAND, 1700 Main St, Santa Monica, CA 90407-2138 (e-mail: Emmett_Keeler@rand.org).

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