Begun J W, Feldman R
Department of Health Administration, Medical College of Virginia, Virginia Commonwealth University.
Adv Health Econ Health Serv Res. 1990;11:79-110.
Research on health manpower regulation has reached a consistent conclusion for the last two decades that is likely to carry into the 1990s: deregulate. Research has progressed in recent years, however, and research in the 1990s will be quite different from that of the past two decades. While the battle cry "never too late to deregulate" will continue to be heard, the "easy" targets, those markets with the least extensive or least important information asymmetry, have already been attacked. What is (or should be) finally emerging in the 1990s is a more challenging appraisal of health manpower regulation, one that recognizes greater complexity in health care markets and consumer preferences than has been recognized in past research. Lessons for the 1990s include the need to recognize, accept, and study information asymmetry and its consequences, and to more closely analyze the hypothesis that occupational interest groups, while meeting their self-interest, also may be serving the commonwealth. Such a reorientation leads us to ask different questions of regulation in future research, all directing attention to the informational attributes of markets: (1) How much information asymmetry exists in different health care markets, and how important is it? In which information-asymmetric markets is manpower regulation most likely to benefit consumers? (2) How can information asymmetry between consumers and providers be reduced, thereby facilitating deregulation? (3) How many regulations, of what type, are consumers willing to eliminate, for what benefits? Simplistic policy recommendations are less likely with this new orientation, and there is a great deal of interesting research awaiting health services researchers.
在过去二十年中，对卫生人力监管的研究得出了一个可能延续到20世纪90年代的一致结论：放松管制。然而，近年来研究有了进展，20世纪90年代的研究将与过去二十年大不相同。虽然“放松管制永远不嫌晚”的战斗口号仍会被听到，但那些“容易”的目标，即信息不对称程度最低或最不重要的市场，已经受到了冲击。20世纪90年代最终（或应该）出现的是对卫生人力监管更具挑战性的评估，这种评估认识到医疗保健市场和消费者偏好比以往研究中所认识到的更为复杂。20世纪90年代的经验教训包括需要认识、接受和研究信息不对称及其后果，并更仔细地分析这样一种假设，即职业利益集团在满足自身利益的同时，也可能在为公众服务。这种重新定位使我们在未来研究中对监管提出不同的问题，所有这些问题都将注意力引向市场的信息属性：（1）不同医疗保健市场存在多少信息不对称，其重要性如何？在哪些信息不对称市场中，人力监管最有可能使消费者受益？（2）如何减少消费者和提供者之间的信息不对称，从而促进放松管制？（3）消费者愿意为了什么利益而取消多少种、何种类型的监管？有了这种新的定位，简单化的政策建议可能性较小，并且有大量有趣的研究等待卫生服务研究人员去做。
