Peabody John W, Luck Jeff
Institute for Global Health, San Francisco Veterans Affairs Medical Center, UCSF School of Medicine, Calif 94105, USA.
Am J Manag Care. 2002 Nov;8(11):997-1007.
For developing countries with constrained economic resources, managed care holds out the promise of being able to control healthcare costs and reduce unnecessary utilization. However, little empirical evidence has been gathered about when managed care techniques can be applied to these countries and no framework considers the macroeconomic context. We propose a straightforward method to evaluate the economic and policy environment of a developing country to assess when managed care might be introduced.
Analysis of available developing country health system and healthcare spending data, review of the available literature, and authors' experience evaluating healthcare reforms in developing countries.
Many countries have implemented managed care techniques, which are driven by policy efforts to increase quality or to control costs. Successful implementation of managed care, however, appears to depend on five major preconditions. One precondition is an adequately developed formal wage sector in which patients have a sufficient ability to pay for healthcare services. Another is an adequate labor supply of trained professionals to support managed care administration, foster competition, and use available information technology.
Although managed care encompasses a range of incentives and arrangements, implementation in developing countries appears to depend on attaining macroeconomic preconditions.
对于经济资源有限的发展中国家而言，管理式医疗有望控制医疗成本并减少不必要的医疗服务使用。然而，关于管理式医疗技术何时可应用于这些国家，几乎没有收集到实证证据，而且没有框架考虑宏观经济背景。我们提出一种直接的方法来评估发展中国家的经济和政策环境，以评估何时可能引入管理式医疗。
分析可得的发展中国家卫生系统和医疗支出数据，回顾现有文献，并结合作者评估发展中国家医疗改革的经验。
许多国家已经实施了管理式医疗技术，这些技术是由提高质量或控制成本的政策努力推动的。然而，管理式医疗的成功实施似乎取决于五个主要前提条件。一个前提条件是有充分发展的正规工资部门，患者有足够的能力支付医疗服务费用。另一个是有足够的经过培训的专业人员劳动力供应，以支持管理式医疗管理、促进竞争并使用可用的信息技术。
尽管管理式医疗包含一系列激励措施和安排，但在发展中国家的实施似乎取决于实现宏观经济前提条件。
