The 10-member commission deferred many central decisions to the legislature and to a new authority that would be created to establish and oversee the new payment system. In doing so, it preserved cautious support from the state’s hospital association, medical society and leading insurers for a proposal that resembles guiding principles more than bill language.

Representatives of those groups joined in a unanimous commission vote for the recommendations. But they made clear that their continued support might depend on devilish details, the kind that will determine whether their members are net losers and, if so, by how much.

It was only by keeping those stakeholders at the negotiating table that the state succeeded in 2006 in vastly expanding subsidized coverage for the uninsured. Maintaining that coalition is expected to be more difficult as the state tries to slow the growth of costs, an effort that typically translates into less revenue for providers and insurers.

The existing “fee for service” system has been roundly criticized as offering incentives that encourage doctors to provide more treatment than is necessary, a significant contributor to the high cost of health care.

Global payments, it is thought, would reward health care providers for keeping their patients well rather than for merely treating their ailments. If the cost of treating a patient was less than the global payment, the provider networks, called accountable care organizations, would keep the difference as profit.