Sigmond R M
Temple University, Philadelphia, PA, USA.
Front Health Serv Manage. 1995 Summer;11(4):5-38; discussion 52-4.
In the current tumultuous health care scene, competitive health plans and capitated delivery systems are becoming the driving forces in the health care marketplace. Although these plans may be successful in containing costs, their competitive nature prevents them from providing leadership in comprehensive, coordinated initiatives to benefit the entire community. In contrast, executives and trustees at the frontiers of health services management are reaching beyond the current scene toward a vision of community care networks. They are taking incremental steps to coordinate care of patients, enrolled populations, and communities--both within and among independent organizations in the public, for-profit, and not-for-profit sectors. As they bring increasing competence in coordination to bear on complex problems of long standing, a health care system that actually delivers more for less to all is a real possibility. My historical perspective, dating back to the studies of the Committee on the Costs of Medical Care (1928-1932), convinces me that community coordination is the missing element in moving from our current fragmented health system to an ever more effective system. This article suggests that the CCMC was on the right track in recommending that every community have an agency to exercise coordination functions, relying on the power of knowledge and persuasion rather than control. Presented here are details of how to organize and manage such an entity as well as a discussion of the nature of the leadership and the incentives required to overcome obstacles to this essential approach.
在当前动荡的医疗保健领域，具有竞争力的医疗计划和按人头付费的医疗服务提供系统正成为医疗保健市场的驱动力。尽管这些计划可能在控制成本方面取得成功，但其竞争性质使其无法在有益于整个社区的全面、协调的举措中发挥引领作用。相比之下，处于医疗服务管理前沿的管理人员和受托人正超越当前的局面，朝着社区护理网络的愿景迈进。他们正在逐步采取措施，在公共、营利和非营利部门的独立组织内部及之间协调患者、参保人群和社区的护理。随着他们将日益增强的协调能力应用于长期存在的复杂问题，一个真正能以更低成本为所有人提供更多服务的医疗保健系统成为现实可能。我从对医疗成本委员会（1928 - 1932年）的研究开始的历史视角使我确信，社区协调是从我们当前分散的医疗系统迈向更高效系统过程中缺失的要素。本文表明，医疗成本委员会在建议每个社区设立一个机构来行使协调职能方面是正确的，该机构依靠知识和说服力的力量而非控制权。这里介绍了如何组织和管理这样一个实体的细节，以及对领导性质和克服这一关键方法障碍所需激励措施的讨论。
