Weil T P
Hosp Health Serv Adm. 1992 Winter;37(4):533-47.
Experience in Germany illustrates that the United States could potentially achieve universal access, comprehensive and high-quality services, and value for the money expended with what is often referred to as a "quasi-private and quasi-public" health care system. The German hospital system is analyzed from a number of perspectives, and it is concluded that this approach has some advantages over a single-payer, monolithic-type national health insurance model. This is primarily because of its pluralistic prepayment system and because the commencement of reimbursement negotiations are without direct governmental intervention. The adoption of the German design in the United States, it is concluded, would result in a sharp change in policy direction from a conceptually procompetitive, market-driven hospital environment to a highly federally regulated, state-administered one. The implementation of the German approach in this country would also require a shift from managed care plans and other third party payers having to micromanage the use of health care services for individual patients to tightly centralized national and state fiscal controls (e.g., institutional global capital and operating budgets) targeted at providers.
德国的经验表明，美国有可能通过通常被称为“半私立半公立”的医疗保健系统实现全民医保、全面且高质量的服务以及资金的合理使用。本文从多个角度对德国医院系统进行了分析，并得出结论：这种模式相较于单一支付方、大一统式的国家医疗保险模式具有一些优势。这主要得益于其多元化的预付体系，以及报销谈判的启动无需政府直接干预。研究得出，在美国采用德国模式将导致政策方向发生急剧转变，从概念上倾向竞争、市场驱动的医院环境转向由联邦高度监管、州政府管理的环境。在本国实施德国模式还需要进行转变，即从管理式医疗计划和其他第三方支付方对个体患者医疗服务使用的微观管理，转向针对医疗机构的严格集中的国家和州财政控制（如机构整体资本和运营预算）。
