McLean Thomas R
Third Millennium Consultants, LLC, Shawnee, Kansas, USA.
J Health Law. 2003 Spring;36(2):325-63.
The Institute of Medicine (IOM) has released the latest publication in its campaign to curtail medical error: Leadership by Example: Coordinating Government Roles in Improving Health Care Quality. In this publication, the IOM recommends that the government utilize its position as the country's largest purchaser of healthcare to institute unified performance standards, create appropriate incentives to improve quality of care, and develop a system to disseminate provider-specific quality information to the public. The author examines these recommendations and the contents of IOM's prior publications and concludes that necessary predicates of IOM's vision are rationing of care and a two-tiered system of healthcare. Thus, if the IOM's recommendations are carried out, the author envisions a healthcare system in which truly state-of-the-art care can only be purchased out of pocket. He concludes that, although Leadership by Example is a rational plan to address escalating healthcare costs, it is unclear both whether the American public would support it if the IOM were explicit about its ultimate impact, and whether the recommendations, in the long run, will prove to be a good thing.
美国医学研究所（IOM）发布了其减少医疗差错行动中的最新出版物：《以身作则：协调政府在改善医疗质量中的作用》。在这本出版物中，IOM建议政府利用其作为该国最大医疗保健购买者的地位，制定统一的绩效标准，创造适当的激励措施以提高医疗质量，并建立一个向公众传播特定医疗服务提供者质量信息的系统。作者审视了这些建议以及IOM先前出版物的内容，并得出结论，IOM愿景的必要前提是医疗配给和两级医疗体系。因此，如果IOM的建议得以实施，作者设想的医疗体系是只有自费才能购买到真正最先进的医疗服务。他总结道，尽管《以身作则》是应对不断攀升的医疗成本的合理计划，但如果IOM明确其最终影响，美国公众是否会支持它尚不清楚，而且从长远来看这些建议是否会被证明是一件好事也不清楚。
