Abstract
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 sacrificce 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.
Original language | English (US) |
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Pages (from-to) | 215-228 |
Number of pages | 14 |
Journal | Health policy |
Volume | 66 |
Issue number | 3 |
DOIs | |
State | Published - Dec 2003 |
Keywords
- Health insurance systems
- Health system reform
- Multi-payer
- Single-payer
ASJC Scopus subject areas
- Health Policy