Brown L D
Health Aff (Millwood). 1992 Winter;11(4):17-37. doi: 10.1377/hlthaff.11.4.17.
Although federal regulation of health care faces cultural obstacles and skepticism among policymakers, it has grown markedly over the past two decades. Beginning in the 1970s with decentralized programs aimed at regulating provider behavior (Health Systems Agencies and certificate of need) and budgets (state rate setting), health care regulation grew more centralized in the 1980s as federal policymakers expanded their influence on behavior (peer review organizations and medical practice guidelines) and budgets (Medicare prospective payment and the resource-based relative value scale). Behavioral regulation has increased the heavy micromanagement that providers face in the United States, while budgetary regulation falls well short of the fiscal macromanagement (global budgets, for example) that other Western nations use. As cost increases intensify, the coalitions that supported limited regulation as a compromise designed to forestall more threatening intrusions may yield to political pressure for firmer central budget controls.
尽管联邦政府对医疗保健的监管面临文化障碍且政策制定者持怀疑态度，但在过去二十年中，它有了显著发展。从20世纪70年代开始，有旨在规范医疗服务提供者行为（卫生系统机构和需求证书）和预算（州费率设定）的分散式项目，到了20世纪80年代，随着联邦政策制定者扩大对行为（同行评审组织和医疗实践指南）和预算（医疗保险预期支付和基于资源的相对价值尺度）的影响，医疗保健监管变得更加集中。行为监管增加了美国医疗服务提供者面临的繁重微观管理，而预算监管远不及其他西方国家所采用的财政宏观管理（例如全球预算）。随着成本增加加剧，那些曾支持有限监管作为旨在防止更具威胁性干预的妥协方案的联盟，可能会屈服于要求更严格中央预算控制的政治压力。
