A comparison of single- and multi-payer health insurance systems and options for reform

P. Hussey, G. F. Anderson

Research output: Contribution to journalArticlepeer-review

52 Scopus citations


A major choice confronting many countries is between single-payer and multi-payer health insurance systems. This paper compares single-payer models in the areas of revenue collection, risk pooling, purchasing, and social solidarity. Single-payer and multi-payer systems each have advantages which may meet countries' priorities for their health insurance system. Single-payer systems are usually financed more progressively, and rely on existing taxation systems; they effectively distribute risks throughout one large risk pool; and they offer governments a high degree of control over the total expenditure on health. Multi-payer systems sacrificce this control for a greater ability to meet the diverse preferences of beneficiaries. Several major reforms of single-payer insurance systems - expansion of the role of private insurance and transformation to a multi-payer system - are then described and illustrated using specific country examples. These reforms have been implemented with some success in several countries but face several important challenges.

Original languageEnglish (US)
Pages (from-to)215-228
Number of pages14
JournalHealth policy
Issue number3
StatePublished - Dec 2003


  • Health insurance systems
  • Health system reform
  • Multi-payer
  • Single-payer

ASJC Scopus subject areas

  • Health Policy


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