Abel-Smith B
London School of Economics and Political Science, Aldwych, England.
Milbank Q. 1992;70(3):393-416.
This article reports on the author's survey of the cost-control measures for health care in 12 European countries during the period from 1983 to 1990. Among these countries the greatest convergence was in the use of the budget as a system of control, reinforced by manpower controls. Budgets were constructed to restrict hospital costs and payments to doctors practicing outside of hospitals. Another strategy was cost sharing for purchase of drugs and, in some cases, for dentistry. Most countries took steps to control expensive medical equipment; others, to restrict entry to medical schools. The European experience demonstrates the technical feasibility of the government's controlling health care costs by regulating supply rather than demand. The key to Europe's success in the use of monopsony power, whereby one purchaser dominates the market. The author contends that regulation works in Europe and questions whether the United States can exert similar control over its coalition of insurers and providers in order to rein in its health care expenses.
本文报道了作者对1983年至1990年期间12个欧洲国家医疗保健成本控制措施的调查。在这些国家中，最大的趋同之处在于将预算作为一种控制体系，并通过人力控制加以强化。制定预算是为了限制医院成本以及向在医院外执业的医生支付的费用。另一种策略是药品采购成本分担，在某些情况下还包括牙科治疗成本分担。大多数国家采取措施控制昂贵的医疗设备；其他国家则限制医学院校的招生人数。欧洲的经验表明，政府通过调节供给而非需求来控制医疗保健成本在技术上是可行的。欧洲成功运用买方垄断力量的关键在于，一个购买者主导着市场。作者认为监管在欧洲行之有效，并质疑美国能否对其保险公司和医疗服务提供者联盟施加类似控制，以控制其医疗保健费用。
