White J
Tulane University Medical Center, USA.
J Health Polit Policy Law. 1999 Aug;24(4):653-96. doi: 10.1215/03616878-24-4-653.
Discussion of health care cost control policy and politics tends to focus on terms such as "market," "government," and "managed care" that are either too general or too value laden to encourage sound analysis. This article proposes an alternative framework for classifying cost control policies. It first distinguishes targets from systems of control. Targets can then be divided into categories of service (e.g., hospital care, pharmaceutical treatment) and components of cost (e.g., price and volume). Systems can be classified in terms of the degree of pooling of finance, ranging from no insurance to a single pool of funds, and how payment of providers is organized, ranging from all payers paying all providers on the same terms to extensive selective contracting among payers and providers. The article analyzes examples of target policy and politics, system policy and politics, and how system choices can influence which targets are targeted how well, so as to show that both policy consequences and political alignments become clearer by using these terms. As one instance, discussions of "managed care" are often confused because the term has two meanings, one referring to target policy and one to system policy.
关于医疗保健成本控制政策和政治的讨论往往集中在“市场”“政府”和“管理式医疗”等术语上，这些术语要么过于宽泛，要么负载过多价值观，不利于进行合理分析。本文提出了一种用于对成本控制政策进行分类的替代框架。它首先区分控制目标和控制系统。然后，目标可分为服务类别（如医院护理、药物治疗）和成本组成部分（如价格和数量）。系统可根据资金筹集程度进行分类，范围从无保险到单一资金池，以及提供者的支付组织方式，范围从所有付款人以相同条款向所有提供者付款到付款人和提供者之间广泛的选择性合同。本文分析了目标政策和政治、系统政策和政治的示例，以及系统选择如何影响哪些目标被瞄准以及效果如何，从而表明使用这些术语会使政策后果和政治联盟都变得更加清晰。例如，关于“管理式医疗”的讨论常常令人困惑，因为这个术语有两种含义，一种指目标政策，另一种指系统政策。
