Gray Virginia, Lowery David, Godwin Erik K
University of North Carolina, Chapel Hill, USA.
J Health Polit Policy Law. 2007 Jun;32(3):457-95. doi: 10.1215/03616878-2007-011.
In the 1990s, strong incentives for managed care organizations to control costs, once regarded as a fortuitous confluence of interests, came to be seen as antithetical to consumers' interests in quality of care. In response to this change in political climate, many states have greatly increased their regulatory control of managed care organizations since the mid-1990s. This activity is surprising in an era when public policy on health care issues is usually described as frozen, gridlocked, and/or stalemated as a result of intense activity on the part of organized interests. We take advantage of the variation in state regulations of health maintenance organizations (HMOs) to discover why some governments are able to address policy problems that are often perceived as intractable in a political if not in a true policy sense. From the history of HMOs, the backlash against managed care, and state responses to that backlash, we first extract a number of hypotheses about state regulatory activity. We then test these hypotheses with data on regulatory adoptions by states during the late 1990s and the early 2000s. Last, we discuss the findings with special attention to the role of politics in health care.
在20世纪90年代，管理式医疗组织控制成本的强烈动机，曾被视为利益的偶然交汇，后来却被视为与消费者对医疗质量的利益相悖。为应对这种政治气候的变化，自20世纪90年代中期以来，许多州大大加强了对管理式医疗组织的监管控制。在一个时代背景下，这种举措令人惊讶，因为在这个时代，由于有组织利益集团的激烈活动，医疗保健问题的公共政策通常被描述为陷入停滞、僵局和/或僵持状态。我们利用各州对健康维护组织（HMO）监管的差异，来探究为何有些政府能够解决那些在政治层面（即便不是在真正的政策层面）常被视为棘手的政策问题。从健康维护组织的历史、对管理式医疗的强烈反对以及各州对这种反对的回应中，我们首先提炼出一些关于州监管活动的假设。然后，我们用20世纪90年代末和21世纪初各州监管采用情况的数据来检验这些假设。最后，我们讨论研究结果，并特别关注政治在医疗保健中的作用。
