Merrill J, McLaughlin C
J Health Polit Policy Law. 1986 Winter;10(4):613-23. doi: 10.1215/03616878-10-4-613.
In response to dramatic rises in health care costs, policymakers have been debating the relative merits of regulatory and competitive strategies as a means of containing costs. One major activity espoused by proponents of competition is the growth of health maintenance organizations (HMOs) which, in their opinion, will result in the market better determining efficient levels of utilization and costs. Extending this argument, the larger the percent of the population in a market area who enroll in HMOs, the greater the market-forcing effect of HMOs in reducing overall hospital expenditures; that is, if HMOs are providing lower-cost care, then the fee-for-service system will be forced to reduce costs in order to be competitive. The authors studied the 25 largest SMSAs from 1971-1981, and controlling for environmental conditions in each market, they examined the impact of both HMO growth and regulatory activity on costs and utilization. They conclude that neither competition nor regulation had a significant impact in reducing overall hospital costs. While there may have been some impact in specific communities, no generalizable effect could be observed. However, the authors did find that increases in costs and utilization were essentially driven by supply factors such as the number of hospital beds or medical specialists in a given community.
为应对医疗保健成本的急剧上升，政策制定者一直在辩论监管策略和竞争策略作为控制成本手段的相对优点。竞争支持者所支持的一项主要活动是健康维护组织（HMO）的发展，他们认为，这将使市场更好地确定有效的利用水平和成本。进一步阐述这一观点，在一个市场区域中加入HMO的人口比例越高，HMO在降低总体医院支出方面的市场强制效应就越大；也就是说，如果HMO提供成本更低的护理，那么按服务收费系统将被迫降低成本以保持竞争力。作者研究了1971年至1981年25个人口最多的标准都市统计区（SMSA），并在控制每个市场环境条件的情况下，研究了HMO增长和监管活动对成本及利用情况的影响。他们得出结论，竞争和监管对降低总体医院成本均无显著影响。虽然在特定社区可能有一些影响，但未观察到普遍适用的效果。然而，作者确实发现，成本和利用率的增加基本上是由供应因素驱动的，如特定社区的医院病床数量或医学专家数量。
