Holahan John
Health Policy Center, Urban Institute, in Washington, DC, USA.
Health Aff (Millwood). 2007 Nov-Dec;26(6):w667-9. doi: 10.1377/hlthaff.26.6.w667. Epub 2007 Sep 18.
There is great variation among states in Medicaid spending per low-income person. This variation has many determinants, including state discretion and differences in prices and amounts of services used. Incentives in Medicaid to have low-income states spend more have generally not worked. The decentralized approach to Medicaid and the variations in spending created thereby have consequences in access and health outcomes that seem to belie a presumed national interest in equity. The current trend toward state-based solutions to health care coverage would likely exacerbate existing variations. A federal solution, though not likely, would be necessary to eliminate state variations.
各州在每个低收入人群的医疗补助支出方面存在很大差异。这种差异有许多决定因素，包括各州的自主权以及所使用服务的价格和数量差异。医疗补助中促使低收入州增加支出的激励措施通常并未奏效。医疗补助的分散式管理方式以及由此产生的支出差异，在医疗服务可及性和健康结果方面产生了一些后果，这些后果似乎与假定的国家在公平性方面的利益相悖。当前基于州层面解决医疗覆盖问题的趋势可能会加剧现有的差异。要消除各州之间的差异，虽然不太可能，但联邦层面的解决方案将是必要的。
