摘要：Recent evaluations of the California Health Service Plan (CHSP) confirmed that financing health care through a single government payer can provide universal coverage—while saving significantly on health care spending—to a degree unparalleled by alternative approaches. Public ownership of the delivery system can further provide authority and accountability for critical reforms that improve the population’s health and quality of care, including coordination of the delivery system. The federal government’s State Planning Grant Program provides states with funding to develop plans to cover their uninsured populations. California created a Health Care Options Project that requested proposals that could expand coverage and contracted with a financial modeler and a qualitative analyst to evaluate the resulting plans. The CHSP was one of 9 plans evaluated through this process. WITH HEALTH INSURANCE premiums on the rise, the issues of health care costs and the uninsured are again appearing on the policy agenda. 1, 2 The State Planning Grant program (SPG) is providing an opportunity for states to draw creatively from their own experiences and those of other countries, as well as from public health principles, 3– 5 in considering how to control costs and expand coverage. The SPG program, administered by the federal Health Resources and Services Administration (HRSA), has funded 1-year grants to 32 states to collect and analyze data on the characteristics of their uninsured populations and to develop plans to provide coverage for all residents that would be equivalent to a benchmark program such as the Federal Employees Health Benefit Plan. The California Health Service Plan (CHSP), developed as part of the California SPG program, is a case in point. Analysis showed that even by conservative estimates, the CHSP (which the author wrote) would achieve both universal coverage and savings over current spending. Delivery system reforms intended to improve the population’s health and quality of care, such as expanded primary care, would also reduce costs. The plan shifts responsibility for cost control from users to providers and does not impose cost sharing such as copayments or deductibles.
