Berliner H S, Burlage R K
Conservation of Human Resources, Columbia University, New York, NY 10025.
Int J Health Serv. 1987;17(4):585-94. doi: 10.2190/XVLP-JC8K-PRWL-EMRK.
In this article we examine the previously little-studied development in U.S. health care--the growth of a proprietary ambulatory care system composed of health maintenance organization, urgent care centers, ambulatory surgicenters, ambulatory diagnostic centers, large group practices, and other delivery modalities. The growth of this system as a result of the ease of access to capital, limited or nonexistent regulation through Certificate of Need or other mechanisms, the growing surplus of physicians, decreases in the use of hospitals as a result of changed insurance benefits and inpatient utilization review, new developments in biotechnology, and computerization and miniaturization of new technological advances is discussed. The reasons for the expanded growth of proprietary chains over nonprofit systems of ambulatory care are also discussed. The article concludes with a discussion of the negative consequences for individual health and the health care system that may be generated by the continued growth of proprietary ambulatory care.
在本文中，我们审视了美国医疗保健领域此前较少被研究的发展情况——一个由健康维护组织、紧急护理中心、门诊手术中心、门诊诊断中心、大型团体医疗实践及其他医疗服务模式组成的私立门诊医疗系统的发展。文中讨论了该系统得以发展的原因，包括获取资金的便利性、通过需求证书或其他机制进行的有限监管或无监管、医生过剩的加剧、因保险福利变化和住院利用审查导致的医院使用率下降、生物技术的新发展以及新技术进步的计算机化和小型化。同时也讨论了私立连锁机构相对于非营利性门诊医疗系统扩张性增长的原因。文章最后讨论了私立门诊医疗的持续增长可能给个人健康和医疗保健系统带来的负面后果。
