A major concern from hospitals about adopting the Canadian national health insurance plan as a model for reform is the potential for limits on hospital capital and operating expenditures set at national and state levels. Also, some hospitals fear that they would receive limited income from patient revenues despite a significant increase in expenses. Germany, with a quasi-private, quasi-public approach, offers a more pluralistic model that might be a more suitable approach, although with either option U.S. hospitals may need to provide more care with relatively fewer dollars.