我國全民健保，以門診定額負擔、住院比例負擔搭配醫療給付費用總額預算的方式，無法對醫療資源浪費發揮充分的抑制效果，所以目前全民健保有相當大的財務壓力。興起於新加坡的醫療儲蓄帳戶制度（Medical Savings Account，簡稱MSA）搭配高自負額健康保險，藉由以自已的MSA帳戶金額支付醫療費用自負額，達到比部份負擔更強的抑制醫療支出浪費效果。因此，本研究企圖透過對MSA制度特性進行研究，找出臺灣地區實施MSA、並藉以達成節制醫療浪費的可行性。 新加坡實施MSA制度，雖然該國醫療支出佔GNP比重很低、國民健康水準很高，但該國並非將MSA專門應用在容易形成浪費之醫項目、且國民非常具守法精神，所以，不能期待移值該國的MSA制度，就能解決我國目前的醫療濫用問題；美國也引進MSA制度，最初為民間企業採用，建立員工的醫療福利，後來經HIPAA立法，法案中提供參與MSA制度之員工及雇主具體的租稅誘因，更進而由政府試辦為期四年的實驗計劃，雖然目前美國引進MSA時間還很短，缺乏實證資料證明MSA之可行性，但該國的引進及發展經驗，值得做為我國思考如何建立MSA制度、以有效節制醫療資源濫用之參考。 目前在國內，羅紀瓊教授及沈富雄、張蔡美、郝龍斌諸位委員紛紛提出醫療儲蓄帳戶的相關方案，他們雖都主張將現行全民健保再劃分成兩部份，其中一部份改由儲蓄帳戶支付，但在劃分方式、醫療支付範圍、帳戶金額來源及分配、給付方式及標準、帳戶金額不足之處理、對弱勢族群之救濟上，則各有不同主張。 本研究主張，設計MSA制度各項細節前，應先進行環境評估，以確實掌握解決問題之適用方案、及設計方案所須之資料；並先確立我國引進MSA制度的主要目標及秉持精神，以助進行整體考量設計。綜合建議為：在設計MSA上，要充分發揮其特長；在制度的公平及有效性間，應取得平衡；帳戶設計成以「戶」或「個人」為單位，在風險世代移轉效果、期間長短、精算等問題上，應進行不同的整體考量；建立配套的租稅、財富誘因；評估採行MSA制度後，對國內保險環境所產生的影響。

　　　　　The lump sum charge system in the outpatient service and the percentage charge system in hospitalization with a global budget payment system can not restrain the over use of medical resources in Taiwan's National Health Insurance. It causes the pressure of deficit. The Medical Savings Accounts, originated in Singapore, pay the deductible of medical expenditure to achieve much more restraining effects than copayment systems. Our research studies on the characteristics of MSA and tries to find out the feasibility of carrying out the scheme in Taiwan's National Health Insurance to restrain the waste of medical using. Implementing the MSA system, Singapore achieves a very low ratio of medical expenditure to GNP and a high standard of national health. However, we cannot expect the same results by transplanting the very same system because the MSA system in Singapore does not operate on easily wasted medical items and their people abide by law in nature. In the United States, the private sectors carried out the MSA first, and then the HIPAA (Health Insurance Portability and Availibility Act) was passed and provided employers and employees with substantial tax advantage incentives. Furthermore, a four-year pilot program was conducted from 1997 to 2000. Though we still don't have enough data to test the feasibility of the MSA scheme from the US experience, their developing processes are worthy to be learned by us. There are many different opinions about the MSA scheme in Taiwan. Our research proposes that we evaluate the environment first in order to choose the right way and to help establish the details of the scheme. It is also suggested that we affirm the objective and spirit of the MSA scheme to help the identified consideration of design.