A comparison of single- and multi-payer health insurance systems and options for reform.
A major choice confronting many countries is between single-payer and multi-payer health insurance systems. This paper compares single-payer models in the areas of revenue collection, risk pooling, purchasing, and social solidarity. Single-payer and multi-payer systems each have advantages which may meet countries' priorities for their health insurance system. Single-payer systems are usually financed more progressively, and rely on existing taxation systems; they effectively distribute risks throughout one large risk pool; and they offer governments a high degree of control over the total expenditure on health. Multi-payer systems sacrifice this control for a greater ability to meet the diverse preferences of beneficiaries. Several major reforms of single-payer insurance systems--expansion of the role of private insurance and transformation to a multi-payer system--are then described and illustrated using specific country examples. These reforms have been implemented with some success in several countries but face several important challenges.
Hussey
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Health Policy and Management, John Hopkins University, 624 N Broadway, Baltimore, MD 21205, USA. phussey@jhsph.edu
Anderson
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GF
D003258:Consumer Behavior / Q000191:economics; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D006302:Health Services Research; D006801:Humans; D007182:Income / Q000145:classification; D015271:Insurance Pools; D015273:Insurance Selection Bias; D007348:Insurance, Health / Q000331:legislation & jurisprudence*; D007349:Insurance, Health, Reimbursement; D009313:National Health Programs / Q000191:economics*; D018855:Single-Payer System