Havighurst C C
J Health Polit Policy Law. 1977 Winter;1(4):471-98. doi: 10.1215/03616878-1-4-471.
The council on Wage and Price Stability recently has discovered evidence suggesting "an unackonwledged potential of the private sector to exert influence and control in the area of health care cost inflation." This article examines the limitations on private-sector cost-control efforts and suggests actions which would permit and encourage private decision makers to be more effective. In particular, private health insurers' potential role in cost control is explored, and some promising insurer strategies are adumbrated. Carefully designed coverage limitations and plan-initiated reviews to exclude nonessential care from coverage are suggested, together with wider use of fixed indemnity payments or negotiated fees and charges (instead of paying unusual and customary rates or incurred costs). Among the steps needed to permit insurers to provide this added service to cost-conscious customers is enforcement of the antitrust laws to prevent doctors' organized resistance to unwanted measures. In general, it is argued that private-sector efforts are likely to be more effective than government-sponsored controls as well as more appropriate in a pluralistic society.
工资与物价稳定委员会最近发现了一些证据，表明“私营部门在控制医疗保健成本通胀方面存在未被认识到的影响力和控制力”。本文探讨了私营部门成本控制努力的局限性，并提出了一些行动建议，这些行动将允许并鼓励私营决策者提高效率。特别地，本文探讨了私营健康保险公司在成本控制中的潜在作用，并概述了一些有前景的保险公司策略。建议精心设计保险范围限制和由保险公司发起的审查，以将非必要护理排除在保险范围之外，同时更广泛地使用定额赔付或协商费用（而不是支付异常和惯例费率或实际发生的费用）。为使保险公司能够向注重成本的客户提供这种额外服务，所需采取的措施之一是执行反垄断法，以防止医生有组织地抵制不受欢迎的措施。总体而言，有人认为，私营部门的努力可能比政府主导的控制措施更有效，在多元化社会中也更合适。
