1 Department of Public Administration and Policy, University at Albany, Albany, New York, USA.
Int J Health Serv. 2018 Jul;48(3):568-585. doi: 10.1177/0020731418779377. Epub 2018 Jun 21.
Described as "universal prepayment," the national health insurance (or single-payer) model of universal health coverage is increasingly promoted by international actors as a means of raising revenue for health care and improving social risk protection in low- and middle-income countries. Likewise, in the United States, the recent failed efforts to repeal and replace the Affordable Care Act have renewed debate about where to go next with health reform and arguably opened the door for a single-payer, Medicare-for-All plan, an alternative once considered politically infeasible. Policy debates about single-payer or national health insurance in the United States and abroad have relied heavily on Canada's system as an ideal-typical single-payer system but have not systematically examined health system performance indicators across different universal coverage models. Using available cross-national data, we categorize countries with universal coverage into those best exemplifying national health insurance (single-payer), national health service, and social health insurance models and compare them to the United States in terms of cost, access, and quality. Through this comparison, we find that many critiques of single-payer are based on misconceptions or are factually incorrect, but also that single-payer is not the only option for achieving universal coverage in the United States and internationally.
被描述为“全民预付款”的全民健康保险（或单一支付者）模式，作为为医疗保健筹集资金和提高中低收入国家社会风险保护的手段，越来越受到国际行为体的推崇。同样，在美国，最近取消和取代《平价医疗法案》的努力失败，再次引发了关于医疗改革下一步走向的辩论，并可以说为单一支付者、全民医疗保险计划（一种曾经被认为在政治上不可行的替代方案）打开了大门。美国和国外关于单一支付者或国家健康保险的政策辩论严重依赖加拿大的系统作为理想的单一支付者系统，但并没有系统地审查不同全民覆盖模式下的卫生系统绩效指标。我们利用现有的跨国数据，将具有全民覆盖的国家分为最佳体现国家健康保险（单一支付者）、国家卫生服务和社会健康保险模式的国家，并根据成本、可及性和质量与美国进行比较。通过这种比较，我们发现，对单一支付者的许多批评要么基于误解，要么是不正确的，但也表明单一支付者不是在美国和国际上实现全民覆盖的唯一选择。
