Alternate strategies for universal coverage: Implications for efficiency

Two strategies could be deployed to achieve universal coverage: augment the current hybrid system of public and private payers or create a new publicly-funded single-payer (PFSP) system such as Medicare-for-All (M4A). Financial sustainability is a critical issue facing both of these strategic options. Recent decades have seen long-term increases in healthcare technology, healthcare expenditures and life expectancy. Innovations that fueled the expenditure increases also contributed to the increase in longevity, and these new treatments were - as a whole - cost-effective. Maintaining ability to finance continued treatment innovations requires increased efficiency in healthcare delivery. Careful payment system design will be required to provide the necessary incentives and flexibility. This is a critical issue for assessing universal coverage strategies.