McCormick Danny, Himmelstein David U, Woolhandler Steffie, Bor David H
Department of Medicine, Cambridge Hospital and Harvard Medical School, Cambridge, MA 02139, USA.
Arch Intern Med. 2004 Feb 9;164(3):300-4. doi: 10.1001/archinte.164.3.300.
Forty-one million Americans have no health insurance and, despite the growth of managed care, medical costs are again increasing rapidly. One proposed solution is a single-payer health care financing system with universal coverage. Yet, physicians' views of such a system have not been well studied.
We surveyed a random sample of physicians (from the American Medical Association Masterfile) in Massachusetts, regarding their views on a single-payer health care financing system and other financing and physician work-life issues that such a system might affect.
Of 1787 physicians, 904 (50.6%) responded to our survey. When asked which structure would provide the best care for the most people for a fixed amount of money, 63.5% of physicians chose a single-payer system; 10.7%, managed care; and 25.8%, a fee-for-service system. Only 51.9% believed that most physician colleagues would support a single-payer system. Most respondents would give up income to reduce paperwork, agree that it is government's responsibility to ensure the provision of medical care, believe that insurance firms should not play a major role in health care delivery, and would prefer to work under a salary system.
Most physicians in Massachusetts, a state with a high managed care penetration, believe that single-payer financing of health care with universal coverage would provide the best care for the most people, compared with a managed care or fee-for-service system. Physicians' advocacy of single-payer national health insurance could catalyze a renewed push for its adoption.
4100万美国人没有医疗保险，而且尽管管理式医疗有所发展，但医疗成本再次迅速上升。一个提议的解决方案是建立一个全民覆盖的单一支付者医疗保健融资系统。然而，医生对这样一个系统的看法尚未得到充分研究。
我们对马萨诸塞州的医生（从美国医学协会主档案中随机抽取）进行了调查，询问他们对单一支付者医疗保健融资系统以及该系统可能影响的其他融资和医生工作生活问题的看法。
1787名医生中，904名（50.6%）回复了我们的调查。当被问及哪种结构能在固定金额下为大多数人提供最佳医疗服务时，63.5%的医生选择了单一支付者系统；10.7%选择了管理式医疗；25.8%选择了按服务收费系统。只有51.9%的人认为大多数医生同事会支持单一支付者系统。大多数受访者愿意为减少文书工作而放弃收入，同意确保提供医疗服务是政府的责任，认为保险公司在医疗服务提供中不应发挥主要作用，并且更愿意在薪资系统下工作。
在管理式医疗渗透率较高的马萨诸塞州，大多数医生认为，与管理式医疗或按服务收费系统相比，全民覆盖的单一支付者医疗保健融资将为大多数人提供最佳医疗服务。医生对单一支付者国家医疗保险的支持可能会促使重新推动其采用。
