Sensitivity to cost
• High (to consumer, and somewhat to provider) if paid by consumer
• Low if paid by third party (private insurance, government)

 
Coverage
• Who is covered:
    Private insurance by ability/willingness to pay?
    Public insurance by population subgroups?
• What is covered: acccording to procedure, health condition, provider type, etc.?

Redistributive effects
• Commercial health insurance: from those with low health expenditures to those with high health expenditures
• Government health insurance: same, plus from high tax payers to low tax payers

Competition in budgeting

Payer	Competing expenditures
Federal govt.	retirement income (social security)
State govt.	education
Employer	pay check
Individual	personal consumption

Bargaining positions of payer and provider
• Provider in stronger position with many payers, as with small private insurers.
• Payer in stronger position when covering many lives, e.g. Medicare
 

Relative tax base and migration of patients seeking financing of care
Federal government:
TAX BASE: strong
MIGRATION: limited to foreign citizens
State governments:
TAX BASE: competing with other states for economic growth (low taxes and expenditures for physical infrastructure and education - not social services)
MIGRATION: concerned that good benefit plans will attract the ill from other states as well as from other nations