Enthoven A C
N Engl J Med. 1978 Mar 23;298(12):650-8. doi: 10.1056/NEJM197803232981204.
The financing system for medical costs in this country suffers from severe inflation and inequity. The tax-supported system of fee for service for doctors, third-party intermediaries and cost reimbursement for hospitals produces inflation by rewarding cost-increasing behavior and failing to provide incentives for economy. The system is inequitable because the government pays more on behalf of those who choose more costly systems of care, because tax benefits subsidize the health insurance of the well-to-do, while not helping many low-income people, and because employment health insurance does not guarantee continuity of coverage and is regressive in its financing. Analysis of previous proposals for national health insurance shows none to be capable of solving most of these problems. Direct economic regulation by government will not improve the situation. Cost controls through incentives and regulated competition in the private sector are most likely to be effective.
该国的医疗费用融资体系饱受严重通胀和不公平问题的困扰。由税收支持的医生按服务收费、第三方中介以及医院费用报销体系，通过奖励增加成本的行为且未能提供节约成本的激励措施，从而导致了通胀。该体系不公平，原因在于政府为那些选择成本更高的医疗体系的人支付更多费用，税收优惠补贴了富人的医疗保险，却没有帮助到许多低收入人群，还因为就业医疗保险无法保证保险覆盖的连续性，且在融资方面具有累退性。对以往国家医疗保险提案的分析表明，没有一个提案能够解决这些问题中的大部分。政府的直接经济监管无法改善这种状况。通过激励措施以及私营部门的规范竞争来控制成本最有可能产生效果。
