Mitchell B M, Schwartz W B
N Engl J Med. 1976 Oct 14;295(16):866-71. doi: 10.1056/NEJM197610142951605.
Two sources of funds are available to underwrite the costs of any national health-insurance plan: prepayments (premiums, payroll taxes and income taxes) and out-of-pocket payments (coinsurance and deductibles). The extent to which taxes rather than premiums are used to finance an insurance program will be the major determinant of how large a share of the costs of health care will be borne by higher-income groups. The extent to which coinsurance and deductible provisions are reduced or waived for low-income persons will have a less important, but still substantial, role in determining how the costs of a program are distributed. These financing principles, once understood, provide a basis for the design of health-insurance legislation that will achieve any pattern of income redistribution that may be desired.
预付款（保费、工资税和所得税）和自付费用（共保费用和免赔额）。税收而非保费用于为保险计划融资的程度，将是高收入群体承担医疗保健费用份额大小的主要决定因素。对于低收入者，共保条款和免赔条款减少或免除的程度，在确定计划费用如何分配方面的作用虽不那么重要，但仍相当可观。一旦理解了这些融资原则，就能为医疗保险立法的设计提供基础，以实现任何可能期望的收入再分配模式。
