Grannemann T W
SysteMetrics/McGraw-Hill, Lexington, MA 02173.
Inquiry. 1991 Fall;28(3):300-5.
The state of Oregon is attempting a controversial restructuring of its Medicaid program that promises to apply effectiveness research to set priorities for medical care. Will the application of such methods control costs and improve access to necessary care for the poor as intended? This paper argues that the answer may depend more on the system used to deliver care than on the priority list itself. Capitated delivery systems may provide the flexibility to be responsive to individual patient needs, while "rationing" in the fee-for-service system risks denying some necessary services to the poor.
俄勒冈州正在尝试对其医疗补助计划进行一项颇具争议的重组，该计划承诺运用有效性研究来确定医疗护理的优先次序。此类方法的应用能否如预期那样控制成本并改善穷人获得必要护理的机会呢？本文认为，答案可能更多地取决于提供护理的系统，而非优先次序清单本身。按人头计费的提供系统或许能灵活应对个体患者的需求，而在按服务收费系统中进行“配给”则有可能使穷人得不到一些必要的服务。
