Universal HealthcareBy NextBestFit
Problem · Common trade-offs

Depends on uncertain evidence or judgments

The approach requires decisions where evidence is incomplete or outcomes are hard to assess. This matters most when mistakes are difficult to reverse and less when decisions can be reviewed as evidence improves.

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Paths that create or worsen it
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Caused or worsened by these paths

A cost these paths share. Each path's page says how it applies there.

International reference pricingBrand-name drug prices far above production costRejected

Reference pricing depends on foreign prices that exchange rates and confidential rebates make difficult to establish.

Prize funds and advance market commitmentsR&D is funded by high prices, which ties innovation to unaffordabilityChosen

Prize funds require judgments about reward sizes that are difficult to set correctly. Prize funds and guaranteed purchases remain untested at large scale.

Value-based prices that reward real innovationR&D is funded by high prices, which ties innovation to unaffordabilityChosen

Basing drug prices on added benefit leads to disputes over how value should be measured.

Shorter training: combined undergrad/medical programsMedical education debt shapes specialty choiceRejected

Programs starting after high school require less mature students to choose their careers earlier.

Evidence-based coverage decisionsLow-value care and overtreatmentChosen

Decisions to stop covering services depend on evidence that is often incomplete.

Cover new treatments at launch, then reassessSlower access to new drugs and technologyChosen

Immediate provisional coverage pays high prices for drugs that may not work while evidence is collected.

Budgets adjust automatically for population, age, and volumeFixed budgets can ration careChosen

Recalculating budgets using demand formulas can lead to disputes over those formulas.

Keep private R&D for most drugs; public funds fill gapsGovernment chooses which research gets fundedRejected

Identifying the research gaps that qualify for public funding is difficult.

Measure outcomes by clinician type and adjust scopeQuality concerns when non-physicians practice independentlyChosen

It is hard to attribute observed outcomes to clinician type when deciding practice scope.