Forum HEALTH ACCOUNTS AND OTHER WELFARE ACCOUNTS

In many countries increasing costs for health careand sick leave insurance are forcing govern-ments to cut back or implement higher user fees. Germany and Sweden are just two recent exam-ples. In many developing countries large segments of the population are not covered by health insur-ance at all. It is feared that universal coverage places too large a burden on public expenditure. This paper discusses health accounts as a way of financing some of the costs of health care and at the same time providing economic incentives to use health care and sick leave insurance more effi-ciently. In the course of this article we discuss some basic principles of savings account based social insurance and experience from other areas of social policy. Pension systems have been reformed in many countries in recent years, moving from public, pay-as-you-go schemes with defined benefits toward systems in which contributions are deposited in a notional or funded personal savings account. Similar reforms for other types of social insurance are much more modest. In Sweden, for example, educational savings accounts are being implement-ed voluntarily by some firms. In the U.S., the Clinton Administration introduced medical sav-ings accounts (MSAs) for the self-employed and employees of small firms. MSAs combine retire-ment-type savings with high-deductible health insurance policies. As discussed below, as of sum-mer 2003 there were proposals under discussion to expand the scope of these medical accounts. Unemployment savings accounts have been in place in Brazil since 1986 (Cunningham 2000) and have been introduced in Chile in 2002. Severance pay systems such as exist in Italy, South Korea and many other countries are also quite similar to unemployment savings accounts.1 Proposals for more comprehensive savings account based reforms have been argued (e.g. Fölster