Fraser I
J Health Polit Policy Law. 1985 Fall;10(3):565-78. doi: 10.1215/03616878-10-3-565.
In several areas of health policy, current concern over rising costs has generated considerably political support for reforms that many in the business have advocated unsuccessfully on philosophical, ethical, or humanitarian grounds for years. Thus, for example, the spiraling cost of caring for the mentally ill and the developmentally disabled in an institutional setting has breathed new life into proposals to bring these groups out into the community where they can live more independently--and more cheaply. But this overlap of quality and frugality goals is only partial. Although alliances with cost-cutters can bring reform, health policy reformers are discovering that they may have to accept a lot of bathwater along with the baby. Medicare reimbursement for hospice care, authorized by Section 122 of PL 97-248, the Tax Equity and Fiscal Responsibility Act of 1982, provides one recent example of this dilemma. This article discusses the results of a survey--conducted by the Office of the Inspector General of the Department of Health and Human Services--to discover how many hospices would seek certification for reimbursement by Medicare, how many patients would be served, and the consequences of this legislation for cost, access, and quality of service.
在卫生政策的几个领域，当前对成本上升的担忧为改革赢得了相当多的政治支持，而多年来商界许多人出于哲学、伦理或人道主义理由倡导这些改革却未成功。例如，在机构环境中照顾精神病患者和发育障碍者的成本不断攀升，使得将这些群体带出机构、融入社区的提议有了新的活力，因为在社区他们可以更独立地生活——而且成本更低。但质量目标和节俭目标的这种重叠只是部分的。尽管与削减成本者结成联盟能够推动改革，但卫生政策改革者发现，他们可能不得不连婴儿带洗澡水一起倒掉。1982年《税收公平与财政责任法》（公法97 - 248）第122节授权的医疗保险临终关怀报销政策，就是这一困境的一个最新例子。本文讨论了美国卫生与公众服务部监察长办公室开展的一项调查结果，该调查旨在了解有多少临终关怀机构会寻求医疗保险报销认证、将服务多少患者，以及这项立法对成本、可及性和服务质量的影响。
