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Prospective political analysis for policy design: Enhancing the political viability of single-payer health reform in Vermont

机译：政策设计的前瞻性政治分析：增强佛蒙特州单一付款人医疗改革的政治可行性

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摘要

Background: In 2011 the state of Vermont adopted legislation that aims to create the nation's first state-level single-payer health care system, a system that would go well beyond national reform efforts. Objectives: To conduct a prospective, institutional stakeholder analysis to guide development of a politically viable, universal health care reform proposal, as commissioned by Vermont's legislature in July 2010. Methods: A total of 64 semi-structured stakeholder interviews with nearly 120 individuals, representing 60 different groups/institutions, were conducted between July and December 2010. Interviews probed stakeholders regarding five major design components: financing options, decoupling insurance from employment, organization/governance, comprehensiveness of benefits, and payment reform. Results: There was a range of opposition and support across stakeholder groups and components, and more remarkably a diversity of views within groups often believed to be unwavering supporters or detractors of comprehensive health reform. Given the balance of conflicting views, relative power, and acceptable trade-offs, the research team proposed a single-payer health care system financed through payroll taxes, decoupled from employment, with a generous benefit package, governed by a public-private intermediary. Conclusions: Prospective political analysis can assist in choosing among a range of technically sound policy options to create a more politically viable health reform package.
机译：背景：2011年，佛蒙特州通过了旨在创建全国首个州级单一支付者医疗保健系统的立法，该系统将远远超出国家改革的范围。目标：根据佛蒙特州立法机构于2010年7月委托进行的前瞻性，机构利益相关者分析，以指导制定具有政治可行性的全民医保改革方案。方法：总共进行了64次半结构化利益相关者访谈，涉及近120人，代表在2010年7月至12月之间进行了60个不同的小组/机构。访谈对利益相关者进行了调查，涉及五个主要设计组成部分：融资选择，保险与就业脱钩，组织/治理，福利的全面性以及支付改革。结果：利益相关者团体和组成部分之间存在着一系列的反对和支持，而且更为明显的是，团体内部的观点通常被认为是全面卫生改革的坚定支持者或反对者。考虑到相互矛盾的观点，相对权力和可接受的折衷之间的平衡，研究小组提出了一种由工资税制提供的单付款人医疗保健系统，该工资制与就业脱钩，并设有由公私合营机构管理的慷慨的福利方案。结论：前瞻性政治分析可以帮助在一系列技术上合理的政策选择中进行选择，以创建一个在政治上更可行的医疗改革方案。

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