Battistella R M, Weil T P
Hosp Health Serv Adm. 1989 Summer;34(2):139-56.
Changing social and economic constraints are precipitating a reformulation of the role of government in the provision of social welfare services. The authors conclude that government intervention in the health sector is bound to expand rather than contract because centralization is the key to reconciling otherwise divergent political demands for spending controls and greater equality of access to quality care for the increasing number of uninsured or underinsured persons. In the past eight years, the federal government has unleashed competitive market principles that have had negative side effects on the nation's health services. Payers, providers, and consumers will likely seek to protect themselves by forming coalitions, as happened recently in Massachusetts where the law now requires employers to provide minimum health insurance benefits to their employees. Escalating pressures to correct the damages from short-term piecemeal solutions to problems of health finance and delivery will provide the chief dynamic for universal health insurance in the United States. New economic, social, and political realities suggest, however, an eclectic strategy for attaining this goal that bears little resemblance to the conventional wisdom that guided health policy throughout the postwar period.
不断变化的社会和经济制约因素促使政府在提供社会福利服务方面的角色重新定位。作者得出结论，政府对卫生部门的干预必然会扩大而非收缩，因为集权是协调对支出控制以及为越来越多未参保或参保不足者提供更高质量医疗服务平等机会等不同政治需求的关键。在过去八年里，联邦政府推行了竞争市场原则，这对美国的卫生服务产生了负面影响。支付方、医疗服务提供者和消费者可能会通过结成联盟来寻求自我保护，就像最近在马萨诸塞州发生的那样，该州法律现在要求雇主为其雇员提供最低限度的医疗保险福利。为纠正短期零碎解决方案给卫生融资和服务问题造成的损害而不断升级的压力，将成为美国全民医疗保险的主要推动力。然而，新的经济、社会和政治现实表明，实现这一目标需要采取一种折衷战略，这与战后时期指导卫生政策的传统观念几乎没有相似之处。
