TABLE 1.

Intervention Options and Effects in Model Simulating the US Health System

Intervention	Effects
Insurance related
Expand insurance coveragea	Would improve access to quality care, meaning better health but also more spending on visits, procedures, and medications. Also would put more demand on limited supply of PCPs and would increase total insurance administration expenses.
Change self-pay fraction for the insureda (cost sharing)	Increased cost sharing would reduce utilization of high-quality office care, meaning worse health but less spending. Also would alleviate some demand on limited supply of PCPs.
Change reimbursement rate for office visits	A lower rate would reduce spending on office visits but also would reduce PCP net income, which may lead to a decline in primary care supply.
Change reimbursement rate for hospital visits	A lower rate would reduce spending on hospital visits but also would hurt the quality of urgent care. A lower rate also would lead to reduced elective hospital capacity, thereby impairing the effectiveness of disease and injury management in some cases.
Simplify insurance (reduce administrative overhead)	Insurance plan standardization would reduce PCP administrative costs and thereby improve PCP income. Single-payer approach would do the same and also would eliminate the marketing, eligibility review, and negotiation costs of private insurance administration.
Provider related
Increase preventive and chronic care quality	Would slow progression of asymptomatic disorders into disease and reduce frequency of acute and urgent episodes, but also would increase spending on office visits and medications while increasing demand on limited supply of PCPs.
Improve urgent care quality	Would reduce mortality and need for inpatient stays and extended care.
Expand primary care supplya	Would alleviate shortages of PCPs, but if a surplus results, would reduce PCP average net income.
Improve primary care efficiency	Would alleviate shortage of PCPs and increase PCP net income.
Coordinate health care	Would reduce volume of office visits as well as elective hospital procedures and inpatient stays without adversely affecting quality of care. Could help alleviate PCP shortages, but if a surplus results, would reduce PCP net income.
Adverse conditions related
Enable healthier behaviorsa	Would reduce the fraction of the population at elevated risk for asymptomatic disorders or disease and injury resulting from unhealthy behavior.
Build safer environmentsa	Would reduce the fraction of the population at elevated risk for disease and injury, and for unhealthy behavior, resulting from an unsafe environment.
Create pathways to advantage	Would increase the flow of people from disadvantaged to advantaged.

Note. PCPs = primary care providers.

^aFor advantaged or disadvantaged subgroups.