Saltman R B
Division of Health Policy and Management, Emory University School of Public Health, Atlanta, Ga. 30329.
JAMA. 1992 Aug 12;268(6):774-9.
Although tax-based and social insurance-based forms of single-source financing differ in how they raise funds, they share a common set of structural characteristics. In particular, they both enable publicly accountable authorities to control aggregate expenditure levels by creating a countervailing power to pressures for increased expenditures from providers. While major reform initiatives are under way in European single-source financing systems, these initiatives have so far sought to improve the efficiency, effectiveness, and/or responsiveness to patterns of service delivery without reducing their commitment to universal access to necessary care. The article concludes with a review of the advantages and disadvantages that could accompany the introduction of a single-source financing system in the United States.
尽管基于税收和基于社会保险的单一来源融资形式在筹集资金的方式上有所不同，但它们具有一组共同的结构特征。特别是，它们都使公共问责机构能够通过对提供者增加支出的压力形成一种抗衡力量来控制总支出水平。虽然欧洲的单一来源融资系统正在进行重大改革举措，但到目前为止，这些举措旨在提高效率、有效性和/或对服务提供模式的响应能力，而不减少其对普遍获得必要医疗服务的承诺。文章最后回顾了在美国引入单一来源融资系统可能带来的优点和缺点。
