Introduction: An all-payer system is a price setting system where rates of payment for healthcare services have not been negotiated between a hospital or health system or a payer but instead by a third party organization, such as Maryland’s Health Services Cost Review Commission (HSCRC), who sets most hospital rates that all payers agree to honor. All payer hospitals focus is on legislative principles in an effort to control costs.

Methods: The methodology for this study was a literature review compiled with overview of All-payer hospital systems and its utilization in a hospital setting. All articles prior to 2000 were eliminated from the search. Twenty-eight references were examined and concluded to have mitigated the inclusion parameters along with benefits and disadvantages of the system.

Results: Since 1976 Maryland has successfully kept hospital costs under control using an all-payer system. Additionally, improvements in length of stay and other health measures have improved. While an all payer system works for Maryland that has a large population in urban areas, other states may not see an improvement if they are larger or more rural. Even with lower controlled rates, Maryland still ranks less favorably in per capita health spending and regional variations than other states.

Discussion/Conclusion: The majority of states are not utilizing the benefits of all payer systems. Implementation can improve healthcare in the US by impeding escalating costs, distinguishing fair payment systems, and increasing the access to care. This research study did not extensively compare other nations all payer systems to Maryland or how it could be implemented in the US. The all payer system has practical implications in the US healthcare system. If programs to cut spending are implemented too quickly, national healthcare could be compromised.