Reeher Grant
Center for Policy Research, Maxwell School of Citizenship and Public Affairs, Syracuse University, USA.
J Health Polit Policy Law. 2003 Apr-Jun;28(2-3):355-85. doi: 10.1215/03616878-28-2-3-355.
Although the nation failed during the past decade to enact large-scale, structural change in government health policy, it has seen health care in the private sector remodeled dramatically during the same period. In this article I argue that a new round of equally significant changes is quite possible, this time at the hands of the national government. More specifically, I argue that for a variety of reasons, both enduring and more recently born, support for the private sector and the market in health care is relatively weak: that given likely trends in costs, demographics, and inequalities, it is likely to get even weaker; and that in the potential coming crisis of the health care system. there will be a real opportunity for seizing the agenda and winning policy battles on the part of would-be reformers pushing large-scale, public sector-oriented changes that go well beyond the recent reform efforts directed at managed care and HMOs.
尽管在过去十年里，该国未能在政府卫生政策方面进行大规模的结构性变革，但在同一时期，其私营部门的医疗保健却发生了巨大的重塑。在本文中，我认为新一轮同样重大的变革很有可能发生，这次将由国家政府主导。更具体地说，我认为，由于各种长期存在和近期出现的原因，对医疗保健领域私营部门和市场的支持相对较弱：考虑到成本、人口结构和不平等方面可能出现的趋势，这种支持可能会变得更弱；而且在即将到来的医疗保健系统潜在危机中，对于那些推动大规模、以公共部门为导向的变革（这些变革远远超出了近期针对管理式医疗和健康维护组织的改革努力）的潜在改革者来说，将有一个真正的机会来掌控议程并赢得政策斗争。
