Skip to content
World Health Systems Facts

Single Payer: CBO (2019), Key Design Components and Considerations for Establishing a Single-Payer Health Care System

Single Payer: Congressional Budget Office, Components of a Single-Payer System

Health System Overview
Political System
Economic System
Population Demographics
Health System Rankings
Health System Outcome Measures
Health System Expenditures
Health System Financing

Health System Coverage
Costs for Consumers
Health System Personnel
Health System Resources and Utilization
Long-Term Care
Health Information and Communications Technologies
Medical Training

Affordable Care Act
Medicaid
Medicare
Veterans Health Administration
Health System History and Development
Research on Healthcare Reform
Health System Future Challenges


“Although single-payer systems can have a variety of different features and have been defined in many ways, health care systems are typically considered single-payer systems if they have these four key features:
• “The government entity (or government-contracted entity) operating the public health plan is responsible for most operational functions of the plan, such as defining the eligible population, specifying the covered services, collecting the resources needed for the plan, and paying providers for covered services;
• “The eligible population is required to contribute toward financing the system;
• “The receipts and expenditures associated with the plan appear in the government’s budget; and
• “Private insurance, if allowed, generally plays a relatively small role and supplements the coverage provided under the public plan.”

Source: Congressional Budget Office, Key Design Components and Considerations for Establishing a Single-Payer Health Care System. May 2019.
https://www.cbo.gov/publication/55150


“Government spending and total national spending on health care would be lower if provider payment rates under a single-payer system were set at Medicare FFS rates rather than at a higher level, such as average commercial rates. Setting payment rates equal to Medicare FFS rates under a single-payer system would reduce the average payment rates most providers receive—often substantially. Such a reduction in provider payment rates would probably reduce the amount of care supplied and could also reduce the quality of care. Studies have found that increases in provider payment rates lead to a greater supply of medical care, whereas decreases in payment rates lead to a lower supply.73 But because those studies are based only on changes in Medicare’s payment rates for a given set of services within the context of a multipayer system, the results may be less relevant to a single-payer system, and providers’ responses to changes in payment rates are difficult to predict under such a system. Under a multipayer system with different payment rates, providers might be able to offset their loss of income from one payer by adjusting their rates for other payers, as well as by adjusting their patient mix toward payers with higher payment rates, but such opportunities would be eliminated or limited under a single-payer system.”

Source: Congressional Budget Office, Key Design Components and Considerations for Establishing a Single-Payer Health Care System. May 2019.
https://www.cbo.gov/publication/55150


“In addition to the short-term effects discussed above, changes in provider payment rates under the single-payer system could have longer-term effects on the supply of providers. If the average provider payment rate under a single-payer system was significantly lower than it currently is, fewer people might decide to enter the medical profession in the future. The number of hospitals and other health care facilities might also decline as a result of closures, and there might be less investment in new and existing facilities. That decline could lead to a shortage of providers, longer wait times, and changes in the quality of care, especially if patient demand increased substantially because many previously uninsured people received coverage and if previously insured people received more generous benefits. How providers would respond to such changes in demand for their services is uncertain. To encourage the supply of providers in the longer term, the government could more heavily subsidize the cost of graduate medical education to encourage people to continue to enter medical professions.”

Source: Congressional Budget Office, Key Design Components and Considerations for Establishing a Single-Payer Health Care System. May 2019.
https://www.cbo.gov/publication/55150


“Public spending would increase substantially relative to current spending if everyone received LTSS benefits. Under the current system, many people receive Medicaid benefits for such services but use their own funds to pay for LTSS before they qualify for Medicaid; state Medicaid programs currently pay about half of the cost of such services. Private insurance accounts for a small portion of LTSS spending.20 Under a single-payer system, government payments could replace payments by individuals and private insurance. Further, if the single-payer system eliminated the Medicaid program, federal spending on LTSS would increase considerably unless the system required states to continue their current funding or unless state (or local) governments covered LTSS benefits entirely.

“Currently, much of LTSS is unpaid (or informal) care provided by family members and friends. If a single-payer system covered LTSS with little or no cost sharing, a substantial share of unpaid care might shift to paid care. That effect could be particularly large if the single-payer plan covered home- and community-based services.”

Source: Congressional Budget Office, Key Design Components and Considerations for Establishing a Single-Payer Health Care System. May 2019.


Selected Resources On Single Payer / “Medicare For All”
A. P. Galvani PhD, et al., The Lancet, 2020: Improving the prognosis of health care in the USA

Cai et al, PLOS Medicine, 2020: Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses

Congressional Budget Office, 2019: Key Design Components and Considerations for Establishing a Single-Payer Health Care System

Political Economy Research Institute, 2018: Economic Analysis of Medicare for All


Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.


Page last updated Jan. 14, 2021 by Doug McVay, Editor.

  • Home
  • About Health Systems Facts
    • Contact Us
    • Join Our Email List
  • Breaking News & Opinion
  • Upcoming Events
  • Seventeen National Health Systems
    • Austria
    • Canada
    • Costa Rica
    • Czech Republic
    • Denmark
    • France
    • Germany
    • Hungary
    • Italy
    • Japan
    • Netherlands
    • South Korea
    • Spain
    • Sweden
    • Switzerland
    • United Kingdom
    • United States
  • Comparing National Health Systems
    • Healthcare Access and Quality Index
    • Sustainable Development Goals Health Index
    • Mirror Mirror 2021
    • World Health Report 2000
    • International Health Systems In Perspective
    • Lessons for US Health Reform
  • Aging
  • Health System Outcomes
  • Healthcare Spending
  • Healthcare Workers
    • Health System Personnel
    • Health Workforce Training
  • Information and Communications Technologies
  • Long-Term Services and Supports
  • People With Disabilities
  • Pharmaceutical Pricing and Regulation
  • Social Determinants & Health Equity
  • Wasteful Spending
  • Various US Health System Proposals
    • Affordable Care Act
    • All Payer
    • Public Option
    • Single Payer / “Medicare For All”
    • Universal Health Coverage
  • Recommended Resources
  • Privacy Policy
    • Cookie Policy
  • Facebook
  • LinkedIn
  • Twitter

© 2019-2022 Real Reporting Foundation | Theme by WordPress Theme Detector

We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking “Accept”, you consent to the use of ALL the cookies.
.
Cookie SettingsAccept
Manage consent

Privacy Overview

This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may affect your browsing experience.
Necessary
Always Enabled
Necessary cookies are absolutely essential for the website to function properly. These cookies ensure basic functionalities and security features of the website, anonymously.
CookieDurationDescription
_GRECAPTCHA5 months 27 daysThis cookie is set by Google. In addition to certain standard Google cookies, reCAPTCHA sets a necessary cookie (_GRECAPTCHA) when executed for the purpose of providing its risk analysis.
cookielawinfo-checkbox-advertisement1 yearThe cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Advertisement".
cookielawinfo-checkbox-analytics11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".
cookielawinfo-checkbox-functional11 monthsThe cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checkbox-necessary11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-others11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-performance11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
viewed_cookie_policy11 monthsThe cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.
Functional
Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features.
Performance
Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors.
Analytics
Analytical cookies are used to understand how visitors interact with the website. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc.
CookieDurationDescription
_ga2 yearsThis cookie is installed by Google Analytics. The cookie is used to calculate visitor, session, campaign data and keep track of site usage for the site's analytics report. The cookies store information anonymously and assign a randomly generated number to identify unique visitors.
_gat_UA-71314304-21 minuteThis is a pattern type cookie set by Google Analytics, where the pattern element on the name contains the unique identity number of the account or website it relates to. It appears to be a variation of the _gat cookie which is used to limit the amount of data recorded by Google on high traffic volume websites.
_gcl_au3 monthsThis cookie is used by Google Analytics to understand user interaction with the website.
_gid1 dayThis cookie is installed by Google Analytics. The cookie is used to store information of how visitors use a website and helps in creating an analytics report of how the website is doing. The data collected including the number visitors, the source where they have come from, and the pages visted in an anonymous form.
Advertisement
Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. These cookies track visitors across websites and collect information to provide customized ads.
CookieDurationDescription
IDE1 year 24 daysUsed by Google DoubleClick and stores information about how the user uses the website and any other advertisement before visiting the website. This is used to present users with ads that are relevant to them according to the user profile.
test_cookie15 minutesThis cookie is set by doubleclick.net. The purpose of the cookie is to determine if the user's browser supports cookies.
Others
Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet.
SAVE & ACCEPT
Powered by CookieYes Logo