• Adam Gaffney, Steffie Woolhandler, and David Himmelstein.
• Harvard Medical School, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA, 02138, USA. agaffney@challiance.org.
• J Gen Intern Med. 2020 Aug 1; 35 (8): 240624172406-2417.

AbstractMost 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.

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