Schlesinger M
Center for Health and Human Resource Policy, John F. Kennedy School of Government, Cambridge, MA 02138.
Milbank Q. 1987;65 Suppl 2:270-96.
The newly competitive health care system reflects both an excess supply of health care providers and a greater sensitivity to price among those purchasing health services. These dual pressures are felt in public programs as well as in private markets. A competitive ethos is also changing popular expectations of the appropriate relation between health care institutions and their communities. These changes offer opportunities for enhanced access to health care for some black Americans, but portend dire restrictions on access for the least-advantaged blacks. They also threaten to reduce significantly the influence exerted by black communities over their local health care providers.
新的竞争性医疗保健系统既反映了医疗保健提供者的供应过剩，也反映了购买医疗服务者对价格更为敏感。公共项目和私人市场都感受到了这双重压力。竞争精神也在改变人们对医疗机构与其所在社区之间适当关系的普遍期望。这些变化为一些美国黑人增加获得医疗保健的机会提供了机遇，但预示着最弱势黑人的就医机会将受到严重限制。它们还可能大幅削弱黑人社区对当地医疗保健提供者的影响力。
