Medical Savings Accounts: Lessons from Singapore

In the Spring 1995 issue of Health Affairs Mark Pauly and John Goodman outlined their proposal for medical savings accounts (MSAs) supplemented with tax credits to purchase insurance and encourage cost-effective consumer behavior. This proposal has been widely debated, both in Washington and across the nation. To further enlighten the debate, Health Affairs presents two accounts of the experience with MSAs in Singapore, which differ over how successful Singapore has been at controlling health spending using MSAs. In part, this difference reflects a divide in the broader debate over the outcomes by which MSAs should be evaluated. It is clear that there is ample room here to sustain a debate between honest, serious parties. The result of the exchange is an enriched discussion that will prepare the reader to reach an informed judgment.