The Effect of Large-scale Health Coverage Expansions in Wealthy Nations on Society-Wide Healthcare Utilization
Most analysts project that a reform like Medicare-for-All that lowers financial barriers to care would cause a surge in the utilization of services, raising costs despite stable or even reduced prices. However, the finite supply of physicians and hospital beds could constrain such utilization increases. We reviewed the effects of 13 universal coverage expansions in capitalist nations on physician and hospital utilization, beginning with New Zealand’s 1938 Social Security Act up through the 2010 Affordable Care Act in the USA. Almost all coverage expansions had either a small (i.e., < 10%) or no effect on society-wide utilization. However, coverage expansions often redistributed care—increasing use among newly covered groups while producing small, offsetting reductions among those already covered. We conclude that in wealthy nations, large-scale coverage expansions need not cause overall utilization to surge if provider supply is controlled. However, such reforms could redirect care towards patients who most need it.
KEY WORDShealthcare reform healthcare utilization
We thank the following individuals for their assistance and guidance:
New Zealand: Ian Powell and Lyndon Keene.
UK: Martin Gorsky; John Mohan; Martin Powell.
Sweden: Finn Diderichsen.
Canada: Greg Marchildon
Finland: Lauri Vuorenkoski
Belgium: Jean-Pierre Unger; Pol De Vos.
Australia: Stephen Duckett. Of note, Dr. Duckett provided the table and citation for reference 128.
Portugal: Pedro Pita Barros.
Greece: Alexis Benos; Elias Kondilis; Charalampos Economou. Of note, Elias Kondilis provided the data displayed in E-Figure 2.
Spain: Vicente Navarro
Norway: Andy Oxman; Ingrid Sperre Saunes.
Taiwan: Tsung-Mei Cheng
Compliance with Ethical Standards
Conflict of Interest
The authors serve as leaders of physicians for a National Health Program (PNHP), a non-profit organization that favors coverage expansion through a single-payer program. None of them receives any compensation from that group; some of Dr. Gaffney’s travel on behalf of the organization is reimbursed by it. The authors report no conflicts of interest with any commercial entities.
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