Rosko M D
Graduate Program in Health and Medical Services Administration, Widener University, Chester, PA 19013.
Inquiry. 1989 Spring;26(1):48-61.
Although the passage of PL 98-21 was accompanied by a flurry of interest in all-payer rate regulation, the popularity of all-payer systems has waned recently. This article attempts to determine if the move away from all-payer systems constitutes a lost opportunity. The performance of the partial-payer Medicare PPS is contrasted with that of the all-payer systems in Maryland and New Jersey. The analysis suggests that all-payer systems not only control costs more effectively than partial-payer systems, but also have inherent structural features conductive to limiting cost shifting and to funding uncompensated care. Analysis of data suggests that from the perspectives of payers, providers, and patients, all-payer rate-setting is more equitable than partial-payer systems.
尽管《第98 - 21号公共法律》的通过引发了对全支付方费率监管的一阵热潮，但全支付方系统的受欢迎程度最近有所下降。本文试图确定摒弃全支付方系统是否意味着错失了一个机会。将部分支付方的医疗保险预付费制度（PPS）的表现与马里兰州和新泽西州的全支付方系统的表现进行了对比。分析表明，全支付方系统不仅比部分支付方系统更有效地控制成本，而且具有有助于限制成本转嫁和为未补偿医疗提供资金的内在结构特征。数据分析表明，从支付方、医疗服务提供者和患者的角度来看，全支付方费率设定比部分支付方系统更公平。
