A system modeled on some sort of medical savings accounts (MSAs) or Singapore's Medisave scheme has been a serious alternative, at least for some, to Taiwan's National Health Insurance program. This article first examines the Medisave scheme implemented in Singapore and the MSAs system in some states of the United States, including their background and the pro's and con's based on their empirical experience. This article then considers the constraints and difficulties if Taiwan were to implement such a program; factors including: the public medical network has been on the wane, the private insurance sector may not be able to pay a constructive role, and the financial market performance might be less than satisfactory. And, the situation of the indigent may be jeopardized, for a Medisave scheme does not promise income redistribution. I recommend that two- models may be taken to implement a MSAs system: one is to construct a three-tier system, and the MSA will provide the financial resources for one of the tiers; the other is to put in place a so-called social managed competition system, in which a MSA will provide part of the dollars for long-term care. It is difficult to fathom the impact of the new system; this article therefore suggests an experiment before a full-scale implementation.