Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses

Autoři: Christopher Cai aff001;  Jackson Runte aff001;  Isabel Ostrer aff001;  Kacey Berry aff001;  Ninez Ponce aff002;  Michael Rodriguez aff003;  Stefano Bertozzi aff004;  Justin S. White aff001;  James G. Kahn aff001
Působiště autorů: UCSF School of Medicine, University of California, San Francisco, San Francisco, California, United States of America aff001;  UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States of America aff002;  David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California, United States of America aff003;  School of Public Health, University of California Berkeley, Berkeley, California, United States of America aff004
Vyšlo v časopise: Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses. PLoS Med 17(1): e1003013. doi:10.1371/journal.pmed.1003013
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003013



The United States is the only high-income nation without universal, government-funded or -mandated health insurance employing a unified payment system. The US multi-payer system leaves residents uninsured or underinsured, despite overall healthcare costs far above other nations. Single-payer (often referred to as Medicare for All), a proposed policy solution since 1990, is receiving renewed press attention and popular support. Our review seeks to assess the projected cost impact of a single-payer approach.

Methods and findings

We conducted our literature search between June 1 and December 31, 2018, without start date restriction for included studies. We surveyed an expert panel and searched PubMed, Google, Google Scholar, and preexisting lists for formal economic studies of the projected costs of single-payer plans for the US or for individual states. Reviewer pairs extracted data on methods and findings using a template. We quantified changes in total costs standardized to percentage of contemporaneous healthcare spending. Additionally, we quantified cost changes by subtype, such as costs due to increased healthcare utilization and savings due to simplified payment administration, lower drug costs, and other factors. We further examined how modeling assumptions affected results. Our search yielded economic analyses of the cost of 22 single-payer plans over the past 30 years. Exclusions were due to inadequate technical data or assuming a substantial ongoing role for private insurers. We found that 19 (86%) of the analyses predicted net savings (median net result was a savings of 3.46% of total costs) in the first year of program operation and 20 (91%) predicted savings over several years; anticipated growth rates would result in long-term net savings for all plans. The largest source of savings was simplified payment administration (median 8.8%), and the best predictors of net savings were the magnitude of utilization increase, and savings on administration and drug costs (R2 of 0.035, 0.43, and 0.62, respectively). Only drug cost savings remained significant in multivariate analysis. Included studies were heterogeneous in methods, which precluded us from conducting a formal meta-analysis.


In this systematic review, we found a high degree of analytic consensus for the fiscal feasibility of a single-payer approach in the US. Actual costs will depend on plan features and implementation. Future research should refine estimates of the effects of coverage expansion on utilization, evaluate provider administrative costs in varied existing single-payer systems, analyze implementation options, and evaluate US-based single-payer programs, as available.

Klíčová slova:

Drug administration – Economic models – Finance – Health economics – Insurance – Medicare – Payment – Pharmacoeconomics


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