2.2. Progressivity, Regressivity, and Burden Distribution in Single-Payer Structures
The structural design of universal health care financing fundamentally shapes how financial risk is shared across socioeconomic groups and how effectively service delivery is shielded from market failures. When governments operate as a unified single payer, purchasing leverage can be consolidated to establish primary care gatekeeping, thereby containing aggregate spending and guaranteeing service access free of charge at the point of delivery [2]. However, the institutional implementation of single-payer frameworks does not automatically guarantee progressive outcomes; structural inequities in household income contributions and unaddressed drivers of medical demand can lead to regressive payment burdens across lower income strata even within consolidated national schemes [5]. Furthermore, macroeconomic pressures and demographic transitions, particularly gradual population ageing, expand resource requirements and test the fiscal resilience of statutory entitlements [6]. Without robust structural pooling and broad revenue sharing mechanisms, national health financing systems risk exacerbating intergenerational disparities and compromising the fiscal sustainability of universal health mandates [2], [6].