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Maryland's all-payer system: a delicate balancing act.

A state-regulated, all-payer system has saved Maryland an estimated $43 billion since 1976 while improving access to health care for state residents. It remains to be seen how healthcare reform will impact the system. Buy-in by hospitals, payers, and even the federal government is a must to keep the all-payer system working. In other states, similar efforts have failed. Uniform rate-setting takes some of the guesswork out of financial planning, but it has also resulted in lower margins and greater debt for Maryland hospitals.