Lesser Cara S, Ginsburg Paul B
Issue Brief Cent Stud Health Syst Change. 2003 May(63):1-6.
Continued high-cost trends are threatening the affordability of health insurance and many consumers' access to care. Early findings from the Center for Studying Health System Change's (HSC) 2002-03 site visits to 12 nationally representative communities show the retreat from tightly managed care continues to shape local health care markets. Employers are aggressively shifting higher health costs to workers, and absent tight managed care controls to limit the use of care and slow payment rate increases, hospitals and physicians in many markets are competing fiercely for profitable specialty services. These developments have sparked growing skepticism about the potential for market-led solutions to the cost, quality and access problems facing the health care system today.
持续的高成本趋势正威胁着医疗保险的可承受性以及许多消费者获得医疗服务的机会。医疗系统变革研究中心（HSC）2002 - 2003年对12个具有全国代表性社区进行实地考察的早期结果表明，从严格管理的医疗模式中退出的趋势仍在继续塑造当地的医疗市场。雇主们正积极地将更高的医疗成本转嫁给员工，而且由于缺乏严格管理的医疗控制措施来限制医疗服务的使用并减缓支付率的增长，许多市场中的医院和医生正在激烈争夺有利可图的专科服务。这些情况引发了人们对市场主导的解决方案能否解决当今医疗系统所面临的成本、质量和可及性问题的日益怀疑。
