Feldstein P J
Health Policy. 1986;6(1):1-20. doi: 10.1016/0168-8510(86)90014-x.
This paper addresses three issues. First, why did market competition emerge in the U.S. health care system? Second, once free of regulatory constraints, how is the structure of the medical care system likely to evolve? Three, what are the implications of market competition for the public as well as for providers? The medical system in the U.S. was highly regulated and conventional wisdom assumed a continuation of these trends. Further, the economic motivation of existing providers was to maintain the status quo; market competition threatens their economic well being. Market competition was primarily a result of private sector forces. Several actions by the government, both intentional and unintentional, aided these private forces. Second, economies of scale and consumer preferences for different delivery systems appear to be important determinants of the new market structure. Lastly, market competition is forcing a redistribution of incomes, both between providers as well as between providers and taxpayers. There is also increasing concern over the plight of the medically indigent, as inadequate government payments become more obvious in a price competitive system.
本文探讨了三个问题。第一，美国医疗保健系统中为何会出现市场竞争？第二，一旦摆脱监管限制，医疗保健系统的结构可能会如何演变？第三，市场竞争对公众以及医疗服务提供者有何影响？美国的医疗系统受到严格监管，传统观念认为这些趋势会持续下去。此外，现有医疗服务提供者的经济动机是维持现状；市场竞争威胁到他们的经济利益。市场竞争主要是私营部门力量作用的结果。政府的一些有意和无意的行动推动了这些私营部门力量。第二，规模经济和消费者对不同医疗服务提供系统的偏好似乎是新市场结构的重要决定因素。最后，市场竞争正在迫使收入在医疗服务提供者之间以及医疗服务提供者与纳税人之间重新分配。随着在价格竞争体系中政府支付不足的问题日益凸显，人们也越来越关注医疗贫困者的困境。
