Blendon R J
Department of Health Policy and Management, Harvard University School of Public Health, Boston, MA 02115.
JAMA. 1988 Jun 24;259(24):3587-93.
An analysis of more than two decades of poll results has identified six major trends in public opinion likely to affect the health care system of the 1990s. Americans favor more rather than less health spending, at least as long as the economy remains strong, and they do not think the deficit problem requires cuts in medical care outlays. Should there be a serious economic downturn, however, the public would reverse itself and would favor reduced spending that relies on a different set of strategies than those favored by most health policy experts, particularly in regard to spending for care for the elderly. In either case, the poll results suggest that Americans may be less inclined to participate in newer forms of medical practice, such as health maintenance organizations or preferred provider organizations, than anticipated, and that the commercialization of health care is leading to a decline in public confidence in the leaders of medicine. This latter trend may result in a lack of trust in professionals' views concerning the quality of care and may presage more stringent government involvement in and regulation of health services.
一项对二十多年民意调查结果的分析，确定了可能影响20世纪90年代医疗保健系统的六大舆论趋势。美国人倾向于增加而非减少医疗支出，至少在经济保持强劲时如此，而且他们认为赤字问题并不需要削减医疗支出。然而，如果出现严重的经济衰退，公众的态度将会转变，会倾向于减少支出，所依赖的策略与大多数卫生政策专家所青睐的不同，特别是在老年人护理支出方面。无论哪种情况，民意调查结果都表明，美国人参与新型医疗实践（如健康维护组织或优选医疗机构）的意愿可能低于预期，而且医疗保健的商业化正在导致公众对医疗行业领导者的信心下降。后一种趋势可能导致对专业人员有关医疗质量观点的不信任，并可能预示着政府将更严格地介入和监管卫生服务。
