Sullivan K
Int J Health Serv. 2001;31(1):55-65. doi: 10.2190/MPV6-F4GM-YRY8-VAW0.
The claim that managed care plans are more efficient than fee-for-service plans has been made so often that it has reached the status of folklore, but the evidence is inconclusive. The claim is usually based on one or both of the following errors: (1) lower medical care costs mean lower total costs (medical plus administrative costs) and (2) lower HMO premiums mean HMOs are more efficient than fee-for-service plans. The first assertion ignores evidence indicating that managed care has driven up administrative costs for both insurers and providers. The second ignores evidence that managed care plans have numerous methods of shifting costs that are unavailable or less available to fee-for-service plans. The lull in health care inflation during the mid-1990s is often cited as evidence that managed care is efficient. But the lull may have been caused not by the spread of managed care but by the near-simultaneous occurrence of four events: a downturn in the insurance underwriting cycle, the 1990-1991 recession, endorsement of managed competition by numerous politicians, and the merger fever triggered by those endorsements.
有人声称管理式医疗计划比按服务收费计划更有效率，这种说法经常出现，几乎成了一种普遍认知，但证据并不确凿。这种说法通常基于以下一个或两个错误观点：（1）医疗成本降低意味着总成本（医疗成本加上行政成本）降低；（2）健康维护组织（HMO）保费较低意味着HMO比按服务收费计划更有效率。第一个观点忽视了表明管理式医疗增加了保险公司和医疗机构行政成本的证据。第二个观点忽视了管理式医疗计划有多种成本转移方法，而按服务收费计划无法使用或较少使用这些方法的证据。20世纪90年代中期医疗保健通胀的缓和常被引为管理式医疗有效率的证据。但这种缓和可能并非由管理式医疗的普及导致，而是由四个事件几乎同时发生所致：保险承保周期的低迷、1990 - 1991年的经济衰退、众多政治家对管理式竞争的支持，以及这些支持引发的并购热潮。
