A proportional co-payment maintains patient oversight for expensive procedures. This system avoids the necessity for policing provider-patient transactions. Needless to say, all premiums and co-payments must be fully deductible to insureds. It is irrational to allow medical deductions to employers but not to insureds, especially since these private expenses relieve the government of the necessity of paying for the care itself. As in any human endeavor, RSFs may be afflicted by incompetence and fraud, so government regulation is a necessity.
Government sets minimum levels of solvency and good management.
It sets actuarial and risk standards. Since medical records must be confidential, RSF members can't be allowed to review the books and records. Therefore strict audit and bonding requirements must be established for all RSFs. High Quality Care Government sets minimum mandatory level of coverage. Care is determined by physician and patient, without interference by outside third parties.