Projected Costs of Single-Payer Healthcare Financing in the United States: A Systematic Review of Economic Analyses (PLOS Medicine)

The United States is the only high-income nation without universal, government-funded or -mandated health insurance employing a unified payment system. The U.S. multi-payer system leaves residents uninsured or underinsured, despite overall health care 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. This review seeks to assess the projected cost impact of a single-payer approach.

Authors conducted a literature search between June 1, 2018, and December 31, 2018, without start date restriction for included studies. They 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 U.S. or for individual states. Their 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. Nineteen (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. Only drug cost savings remained significant in multivariate analysis. Included studies were heterogeneous in methods, which precluded the authors from conducting a formal meta-analysis.

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• Journal Article: Projected Costs of Single-Payer Healthcare Financing in the United States: A Systematic Review of Economic Analyses