Including an all-payer reimbursement system in a universal health insurance program

This article examines the feasibility of including an all-payer reimbursement system in a universal health care program in the United States. An all-payer system would keep intact the current array of private and public insurers, but would require that they each pay the same price for hospital and physician services. The article concludes that an all-payer system would face far fewer political barriers than a purely government-financed system. Furthermore, it has a number of advantages over the financing schemes currently used, particularly with respect to enhancing access to care and controlling costs. But there are several potential problems: agreeing on a common payment rate; controlling the volume of services provided; devising a way of incorporating alternative delivery systems; and dealing with the issue of whether providers will be able to "balance bill". The extent to which these problems can be solved will, to a large degree, determine whether an all-payer system can live up to its promise.