Brink S D
Hosp Health Serv Adm. 1986 Sep-Oct;31(5):16-28.
The successful health care organization of the 1990s will evolve from the changing relationships between buyers, providers, and consumers of health care. Under the traditional fee-for-service system, the interests of the three groups were often in conflict. As buyers, primarily government and private purchasers, become more involved in the health care industry and demand cost reductions, relationships between buyers, providers, and consumers will be substantially different. Health care organizations that hope to survive and prosper will need to develop new skills such as performance standards, risk-sharing arrangements, and selection and pricing criteria for this changed environment. They will also need to become involved in all aspects of the provision of health care, with responsibility for management, marketing, and maintaining quality while controlling money, services, and promises. Buyers will increasingly demand certain features from health care organizations, including flexibility in benefits and financial arrangements; controls on price and utilization of services; monitoring the quality of care; and financial stability. Organizations that come close to this ideal are likely to become a dominant force in the health care field.
20世纪90年代成功的医疗保健机构将从医疗保健的购买者、提供者和消费者之间不断变化的关系中演变而来。在传统的按服务收费体系下，这三个群体的利益常常相互冲突。随着主要作为购买者的政府和私人采购商更多地涉足医疗保健行业并要求降低成本，购买者、提供者和消费者之间的关系将截然不同。希望生存和繁荣的医疗保健机构将需要培养新技能，如针对这种变化了的环境制定绩效标准、风险分担安排以及选择和定价标准。它们还需要参与医疗保健提供的各个方面，负责管理、营销并在控制资金、服务和承诺的同时保持质量。购买者将越来越多地要求医疗保健机构具备某些特征，包括福利和财务安排的灵活性；对服务价格和使用的控制；对医疗质量的监测；以及财务稳定性。接近这一理想状态的机构很可能会成为医疗保健领域的主导力量。
