Bloche M Gregg
Georgetown University Law Center, Washington, DC, USA.
Health Aff (Millwood). 2007 Sep-Oct;26(5):1315-27. doi: 10.1377/hlthaff.26.5.1315.
Broad adoption of "consumer-directed health care" would probably widen socioeconomic disparities in care and redistribute wealth in "reverse Robin Hood" fashion, from the working poor and middle classes to the well-off. Racial and ethnic disparities in care would also probably worsen. These effects could be alleviated by adjustments to the consumer-directed paradigm. Possible fixes include more progressive tax subsidies, tiering of cost-sharing schemes to promote high-value care, and reduced cost sharing for the less well-off. These fixes, though, are unlikely to gain traction. If consumer-directed plans achieve market dominance, disparities in care by class and race will probably grow.
广泛采用“消费者导向型医疗保健”可能会扩大医疗保健方面的社会经济差距，并以“反向罗宾汉”的方式重新分配财富，即从贫困和中产阶级劳动者流向富裕阶层。医疗保健方面的种族和族裔差距可能也会加剧。这些影响可以通过对消费者导向型模式进行调整来缓解。可能的解决办法包括更具累进性的税收补贴、对成本分摊方案进行分层以促进高价值医疗保健，以及减少对较贫困人群的成本分摊。然而，这些解决办法不太可能获得认可。如果消费者导向型计划在市场上占据主导地位，那么不同阶层和种族在医疗保健方面的差距可能会扩大。
