Individual health savings accounts are an important part of the current basic medical insurance system for urban workers in China. Since 1998 when the system of personal medical insurance accounts was first implemented, there has been considerable controversy over its function and significance within different social communities. This paper analyzes the main problems in the practical implementation of individual medical insurance accounts and discusses the social and cultural foundations for the establishment of family health savings accounts from the perspective of (...) Chinese Confucian familism. Accordingly, it addresses the direction of the reform and the development of the current system of individual health insurance accounts in China. (shrink)