Weil Thomas P
Int J Health Plann Manage. 2003 Jul-Sep;18(3):247-65. doi: 10.1002/hpm.713.
The increased enrollment in managed care plans, merger mania and the development of politically and financially powerful integrated delivery systems have significantly complicated the governance of U.S. healthcare organizations. These modifications in fiscal incentives and the corporate restructuring undertaken by American health organizations has resulted in limited fiscal savings or improvements in access to care. As a result, trustees are now faced with divesting their losers, and shuttering facilities and services to reduce fixed costs. Decision-making by trustees will be further thwarted in the future by: their institutions being forced to deliver more care without a proportional increase in revenues; physicians seeking to obtain more ambulatory revenues at a hospital's expense; the inability to adequately finance mental health and long-term care services except among the wealthy; the number of divestitures increasing so that eventually the organizational focus for most IDSs will once again be on regionally oriented hospital systems; and much more difficulty being experienced in attracting sufficiently qualified personnel to deliver high quality health services. Finally, many of these findings relevant to the United States also are being shared by governing boards in Canada, Germany, The Netherlands and the United Kingdom.
管理式医疗计划参保人数的增加、并购热潮以及政治和经济实力强大的整合式医疗服务体系的发展，已使美国医疗保健组织的治理变得极为复杂。美国医疗组织在财政激励措施方面的这些变化以及进行的公司重组，导致财政节约有限，或在医疗服务可及性方面改善甚微。结果，受托人现在面临剥离亏损业务、关闭设施和服务以降低固定成本的局面。未来，受托人在决策时还将受到以下因素的进一步阻碍：其机构被迫在收入未按比例增加的情况下提供更多医疗服务；医生试图以医院为代价获取更多门诊收入；除了富人之外，无法为心理健康和长期护理服务提供充足资金；剥离业务的数量不断增加，以至于最终大多数整合式医疗服务体系的组织重点将再次转向以地区为导向的医院系统；以及在吸引足够合格的人员来提供高质量医疗服务方面遇到更多困难。最后，加拿大、德国、荷兰和英国的董事会也认同许多与美国相关的这些发现。
