Principles for a national health program: a framework for analysis and development.

Growing gaps in health insurance coverage have generated increased interest in enactment of major reforms. A framework for evaluating proposals embodying different approaches to a national health program is offered, highlighting seven dimensions: inclusiveness of coverage; comprehensiveness of benefits; financing methods; efficiency of resource utilization; extent of planning and market forces in resource allocation; accountability to beneficiaries; and political feasibility. Four health care reform bills in the Congress are shown either to emphasize political feasibility at the expense or universal coverage and comprehensive benefits, or to stress coverage, benefits, and system reform at the cost of such feasibility.