University of Washington, School of Medicine, Seattle, WA, USA.
J Law Med Ethics. 2012 Fall;40(3):574-81. doi: 10.1111/j.1748-720X.2012.00690.x.
Various kinds of consumer-driven reforms have been attempted over the last 20 years in an effort to rein in soaring costs of health care in the United States. Most are based on a theory of moral hazard, which holds that patients will over-utilize health care services unless they pay enough for them. Although this theory is a basic premise of conventional health insurance, it has been discredited by actual experience over the years. While ineffective in containing costs, increased cost-sharing as a key element of consumer-driven health care (CDHC) leads to restricted access to care, underuse of necessary care, and lower quality and worse outcomes of care. This paper summarizes the three major problems of U.S. health care urgently requiring reform and shows how cost-sharing fails to meet that goal.
在过去的 20 年里，美国尝试了各种以消费者为导向的改革，试图控制医疗保健成本的飙升。这些改革大多基于道德风险理论，即患者只有在为医疗服务支付足够费用的情况下才会过度使用医疗服务。尽管这一理论是传统健康保险的基本前提，但多年来的实际经验已经证明这一理论是站不住脚的。虽然增加成本分担作为消费者驱动的医疗保健（CDHC）的一个关键要素并没有有效地控制成本，但它导致了获得医疗服务的机会受限、必要医疗服务的使用不足以及医疗质量和结果的下降。本文总结了美国医疗保健急需改革的三个主要问题，并展示了成本分担如何未能实现这一目标。
