In 1991, the NCIOM convened the Health Access Forum to reach a consensus on how to address inadequate access to health care for the uninsured and underinsured in North Carolina. The Forum’s proposal outlines a fundamental restructuring of the healthcare delivery system that includes universal access to basic health services; controlling costs by encouraging competition among organized delivery systems, which integrate financing and delivery of care in ways that promote quality and minimize costs; specific reforms and cost reduction measures in such areas as conflict of interest, medical malpractice and defensive medicine; greater equity by using tax-based financing (based on ability to pay) in lieu of premiums.