Coburn A F, Mueller K J
Maine Rural Health Research Center, University of Southern Maine, Portland 04103, USA.
J Rural Health. 1995 Winter;11(1):22-31. doi: 10.1111/j.1748-0361.1995.tb00393.x.
There was considerable support in most major health reform bills considered by the 103rd Congress for the development of rural integrated service networks. The demise of comprehensive health reform, together with the pace of current market-driven changes in the health care system, suggests the need to assess the impact of specific policy strategies considered in the last Congress on rural integrated service network development. Toward this end, this article evaluates the rural health policy strategies of the major bills in relation to three essential preconditions for the development of rural integrated service networks: (1) the need for a more stable financial base for rural providers; (2) the need for administrative, service and clinical capacity to mount a successful network; and finally, (3) the need for appropriate market areas to ensure fair competition among networks and plans. Key policy strategies for supporting rural network development include reform of insurance and payment policies, expansion of targeted support and technical assistance to the underserved, limited-capacity rural areas, and policies governing purchasing groups or alliances that will ensure appropriate treatment of rural providers and networks.
第103届国会审议的多数重大医疗改革法案都大力支持农村综合服务网络的发展。全面医疗改革的失败，以及当前医疗保健系统由市场驱动的变革速度，表明有必要评估上届国会审议的具体政策策略对农村综合服务网络发展的影响。为此，本文根据农村综合服务网络发展的三个基本前提条件，评估了主要法案的农村卫生政策策略：（1）农村医疗服务提供者需要更稳定的资金基础；（2）成功建立网络需要行政、服务和临床能力；最后，（3）需要适当的市场区域，以确保各网络和计划之间的公平竞争。支持农村网络发展的关键政策策略包括保险和支付政策改革、向服务不足的有限能力农村地区扩大有针对性的支持和技术援助，以及管理采购团体或联盟的政策，以确保对农村医疗服务提供者和网络进行适当的待遇。
