Enthoven A C, Kronick R
Graduate School of Business, Stanford University, CA 94305.
JAMA. 1991 May 15;265(19):2532-6.
Roughly 35 million Americans have no health care coverage. Health care expenditures are out of control. The problems of access and cost are inextricably related. Important correctable causes include cost-unconscious demand, a system not organized for quality and economy, market failure, and public funds not distributed equitably or effectively to motivate widespread coverage. We propose Public Sponsor agencies to offer subsidized coverage to those otherwise uninsured, mandated employer-provided health insurance, premium contributions from all employers and employees, a limit on tax-free employer contributions to employee health insurance, and "managed competition". Our proposed new government revenues equal proposed new outlays. We believe our proposal will work because efficient managed care does exist and can provide satisfactory care for a cost far below that of the traditional fee-for-service third-party payment system. Presented with an opportunity to make an economically responsible choice, people choose value for money; the dynamic created by these individual choices will give providers strong incentives to render high-quality, economical care. We believe that providers will respond to these incentives.
大约3500万美国人没有医保覆盖。医疗保健支出失去控制。医保覆盖和成本问题紧密相关。重要的可纠正原因包括无成本意识的需求、一个未为质量和经济性而组织起来的体系、市场失灵，以及公共资金未公平或有效地分配以推动广泛覆盖。我们提议设立公共赞助机构，为那些未参保者提供补贴覆盖，强制雇主提供医疗保险，所有雇主和雇员缴纳保险费，限制雇主对雇员医疗保险的免税缴费，并实行“管理式竞争”。我们提议的新政府收入与提议的新支出相等。我们相信我们的提议将会奏效，因为高效的管理式医疗确实存在，并且能够以远低于传统按服务收费第三方支付体系的成本提供令人满意的医疗服务。当有机会做出经济上负责任的选择时，人们会选择性价比高的；这些个人选择所创造的动态机制将给予医疗服务提供者强大的激励来提供高质量、经济高效的医疗服务。我们相信医疗服务提供者会对这些激励做出回应。
