Enthoven A C
N Engl J Med. 1978 Mar 30;298(13):709-20. doi: 10.1056/NEJM197803302981304.
Medical costs are straining public finances. Direct economic regulation will raise costs, retard beneficial innovation and be increasingly burdensome to physicians. As an alternative, I suggest that the government change financial incentives by creating a system of competing health plans in which physicians and consumers can benefit from using resources wisely. Main proposals consist of changed tax laws, Medicare and Medicaid to subsidize individual premium payments by an amount based on financial and predicted medical need, as well as subsidies usable only for premiums in qualified health insurance or delivery plans operating under rules that include periodic open enrollment, community rating by actuarial category, premium rating by market area and a limit on each person's out-of pocket costs. Also, efficient systems should be allowed to pass on the full savings to consumers. Finally, incremental changes should be made in the present system to alter it fundamentally, but gradually and voluntarily. Freedom of choice for consumers and physicians should be preserved.
医疗成本正使公共财政不堪重负。直接的经济监管会增加成本、阻碍有益的创新，且对医生的负担也会越来越重。作为一种替代方案，我建议政府通过创建一个竞争性医疗计划体系来改变财政激励措施，在这个体系中，医生和消费者都能从明智地使用资源中受益。主要提议包括修改税法、医疗保险和医疗补助计划，根据经济状况和预测的医疗需求为个人保费支付提供补贴，以及仅用于符合条件的医疗保险或按包括定期开放参保、按精算类别进行社区评级、按市场区域进行保费评级以及对个人自付费用设限等规则运营的医疗服务提供计划的保费补贴。此外，应允许高效的体系将全部节省的费用让利给消费者。最后，应对现行体系进行渐进式变革，从根本上改变它，但要循序渐进且出于自愿。应保留消费者和医生的选择自由。
