Starr P, Zelman W A
Health Aff (Millwood). 1993;12 Suppl:7-23. doi: 10.1377/hlthaff.12.suppl_1.7.
A new approach to universal health insurance combining managed competition and global budgets promises to break the impasse blocking comprehensive health reform. The central innovation is the development of regional health insurance purchasing cooperatives (HIPCs) as managers and reorganizers of the market and platforms for global budgets. Financing would be based on community-rated premiums, with obligations to employers capped as a percentage of payroll and to individuals as a percentage of family income. Budgets would cap the mandated core of spending and set a target for out-of-pocket expenditures.
一种将管理式竞争与全球预算相结合的全民健康保险新方法有望打破阻碍全面医疗改革的僵局。核心创新在于发展区域医疗保险采购合作社（HIPC），使其成为市场管理者、重组者以及全球预算平台。融资将基于社区费率保费，雇主的缴费义务以工资的一定比例为上限，个人的缴费义务以家庭收入的一定比例为上限。预算将限定法定核心支出，并设定自付费用目标。
