Mechanic D
N Engl J Med. 1978 Feb 2;298(5):249-54. doi: 10.1056/NEJM197802022980505.
Cost containment requires changes either in patterns of consumption or in the way services are provided. Although the former includes prevention, changing social expectations and finding suitable substitutes for some types of care, the latter involves mix of personnel technologic inputs, auspices of care and the content of encounters. Ultimately, the future of medical care and cost containment depends on advances in biomedical and health-services research. In the short run, costs will be contained increasingly by rationing mechanisms. Whereas cost sharing is intended to affect consumer behavior, implicit rationing, as through capitation and prospective budgeting, is intended to encourage physicians to make tougher allocation decisions. Explicit rationing, in contrast, depends more on administrative decisions that limit physician discretion. A better understanding of the effects of different rationing technics on patient and physician behavior and the quality of care, as well as on cost, is required.
成本控制要求在消费模式或服务提供方式上做出改变。虽然前者包括预防、改变社会期望以及为某些类型的护理找到合适的替代方案，但后者涉及人员技术投入的组合、护理的主办机构以及诊疗过程的内容。最终，医疗保健和成本控制的未来取决于生物医学和卫生服务研究的进展。短期内，成本将越来越多地通过配给机制来控制。成本分担旨在影响消费者行为，而隐性配给，如通过按人头付费和前瞻性预算，旨在鼓励医生做出更严格的分配决策。相比之下，显性配给更多地依赖于限制医生自由裁量权的行政决策。需要更好地了解不同配给技术对患者和医生行为、护理质量以及成本的影响。
