University of Nevada, Las Vegas, USA.
J Health Polit Policy Law. 2010 Feb;35(1):29-48. doi: 10.1215/03616878-2009-039.
Since the 1990s, state governments have been leaders of health care reform. Today, approximately 47 million people are without health insurance. As health care costs and uninsurance levels continue to rise, states are pursuing a variety of government- and market-based strategies to address this growing social problem. Health care research has indicated that state-based programs have proven to be successful in extending access to coverage. However, the question remains as to whether the market-based programs have had a positive impact on state health care. Advocates for market-based state health programs argue that the reforms benefit the greater good because they serve an economic development function by improving the economic productivity and overall health of state citizens. Whether market-based policies are accomplishing these goals is a matter of debate. This study examines the effects of the various market-based state policies. The evidence generated by this research sheds light on the societal effectiveness of market-based health care strategies used by state governments. The results of our analysis indicate that programs enacted by states to promote increased access to medical care have developmental effects beyond the client population directly served.
自 20 世纪 90 年代以来，州政府一直是医疗改革的领导者。如今，大约有 4700 万人没有医疗保险。随着医疗保健成本和未保险水平的持续上升，各州正在采取各种基于政府和市场的策略来解决这一日益严重的社会问题。医疗保健研究表明，基于州的计划已被证明在扩大覆盖范围方面取得了成功。然而，市场为基础的计划是否对州级医疗保健产生了积极影响仍存在疑问。支持基于市场的州卫生计划的人认为，这些改革符合公益，因为它们通过提高州公民的经济生产力和整体健康水平，发挥了经济发展的作用。基于市场的政策是否能够实现这些目标是一个有争议的问题。本研究考察了各种基于市场的州政策的影响。这项研究产生的证据揭示了州政府使用的基于市场的医疗保健战略在社会层面上的有效性。我们的分析结果表明，各州为促进更多人获得医疗服务而制定的计划除了直接服务的客户群体之外，还具有发展效应。
