Tunis S R, Gelband H
Congress of the United States, Washington, DC 20510.
Health Policy. 1994 Oct-Dec;30(1-3):335-96. doi: 10.1016/0168-8510(94)00692-8.
The US health care system reflects the free market of the US economy--there is no fixed budget and no limit on expenditures in the loosely structured matrix of largely private-sector health industry components. Mainly because of the inaccessibility of adequate health care for a large segment of the population, and because of the enormous cost of care threatens financial ruin for many more people, the first major reform of the system was debated in Congress for most of 1994, though, in the end, no leglislation was passed. One focus of the debate on spending has been the problem of excessive use of expensive medical technology and the need for some control, which, by and large, is lacking in the existing system. Health care technology assessment itself is a thriving industry in the United States, used by government, insurers, medical societies, hospitals, and other groups for their own purposes. At the national policy level, few opportunities for technology assessment to affect the health care industry exist, so most effort is directed at trying to affect medical practice at the level of the individual hospital and practitioner. The discernible effect of technology assessment has been minimal.
美国医疗保健系统反映了美国经济的自由市场——在这个结构松散、主要由私营部门医疗行业组成部分构成的体系中，没有固定预算，支出也没有限制。主要由于很大一部分人口无法获得足够的医疗保健服务，而且医疗保健的巨大成本使更多人面临经济破产的威胁，1994年的大部分时间里，国会对该系统的首次重大改革进行了辩论，不过最终没有通过任何立法。关于支出的辩论焦点之一是昂贵医疗技术的过度使用问题以及进行某种控制的必要性，而现有系统在很大程度上缺乏这种控制。医疗保健技术评估本身在美国是一个蓬勃发展的行业，政府、保险公司、医学协会、医院和其他团体都出于自身目的加以利用。在国家政策层面，技术评估影响医疗保健行业的机会很少，因此大多数努力都旨在试图在个别医院和从业者层面影响医疗实践。技术评估的明显效果微乎其微。
