Needleman J
Harvard School of Public Health, Boston, USA.
Public Health Rep. 1999 Mar-Apr;114(2):108-19. doi: 10.1093/phr/114.2.108.
Conversion of hospitals, health insurers, and health plans from nonprofit to for-profit ownership has become a focus of national debate. The author examines why nonprofit ownership has been dominant in the US health system and assesses the strength of the argument that nonprofits provide community benefits that would be threatened by for-profit conversion. The author concludes that many of the specific community benefits offered by nonprofits, such as care for the poor, could be maintained or replaced by adequate funding of public programs and that quality and fairness in treatment can be better assured through clear standards of care and adequate monitoring systems. As health care becomes increasingly commercialized, the most difficult parts of nonprofits' historic mission to preserve are the community orientation, leadership role, and innovation that nonprofit hospitals and health plans have provided out of their commitment to a community beyond those to whom they sell services.
医院、健康保险公司和健康计划从非营利性所有制转变为营利性所有制已成为全国性辩论的焦点。作者研究了为何非营利性所有制在美国医疗体系中占据主导地位，并评估了这样一种观点的说服力，即非营利组织提供的社区福利会因转变为营利性而受到威胁。作者得出结论，非营利组织提供的许多特定社区福利，如对贫困人口的护理，可通过公共项目的充足资金得以维持或替代，而且通过明确的护理标准和适当的监测系统能够更好地确保治疗的质量和公平性。随着医疗保健日益商业化，非营利医院和健康计划基于对社区（而非仅对其服务对象）的承诺而提供的社区导向、领导作用和创新，是其历史使命中最难保留的部分。
