Adverse selection and single payer systems

In single payer systems, the problem of adverse selection in health insurance is solved because the single payer must cover all people. Because the single payer cannot avoid covering any individual, there is no strategic gaming on coverage decisions. There may, however, be strategic decisions made on the treatment of patients. Consider the case of…

Can single payer systems work?

Much of the discussions of the pros and cons of single payer systems are ideological.  Single payer advocates will say they are fair, potentially can leverage economies of scale, and more equitable.  Single payer opponents will argue that they are inefficient, and restrict choice. An interesting paper from Tomoki Fuji (2018), shows that the answer…

Pay caps on nurses in the UK

I’m finishing my time in the UK today and head back home tomorrow.  The British Society for Rheumatology 2017 conference was interesting, on the news the key headlines were pay for National Health Service employees, nurses in particular. Due to budget shortfalls, the NHS froze nurse pay between 2010 and 2012.  Beginning in 2012, pay raises resumed…

Healthcare for all in Latin America?

The Economist has an interesting article surveying some of the efforts in Latin America to expand health insurance coverage.  Below is an excerpt: One model is that of a tax-financed system with government as sole payer (as in Britain’s National Health Service). That applies, of course, to the famed health service in communist Cuba, as well…

Is Massachusetts getting a singler payer system?

Maybe, if Donald Berwick becomes governor.  Mr. Berwick is the former administrator of the Centers for Medicare and Medicaid Services (CMS). He ran CMS between 2010 and 2011, but left when Senate Republicans blocked his confirmation to lead the agency permanently.  Now, WonkBlog reports that Mr. Berwick is running for governor of Massachusetts.  His platform claims that the state–whose earlier…

Healthcare Outsourcing in the UK

Many liberals laud Europe’s government-run health care sectors as a model to emulate.  In particular, Great Britain’s National Health Service (NHS) often is seen as the ideal single payer system.  In reality, however, the British government itself does not supply all services. A study from the Public Services International Research Unit (PSIRU) describes the gradual…

Is the U.S. a single-payer system?

Most people stereotype European economies as a single payer system whereas the U.S. uses a system of private insurance that is largely unregulated.  This characterization is largely false.  The U.S. has extensive regulation.  Further, the U.S. federal government pays for the largest share of health care.  According to a CHCF report, in 2010, the federal…

The Development of Universal Health Care in Sweden

Sweden adopted universal health coverage in 1955.  How did the universal health coverage develop?  A 2004 World Health Organization report provides the answer. Health insurance in the 19th century mostly occurred through mutual aid organizations, which paid out sickness benefits if their members became ill.  By 1885, about 10% of workers had joined “Friendly Societies.” …