Craig J, Koleda M
Int J Health Serv. 1978;8(2):329-49. doi: 10.2190/XG19-M4FQ-HAA7-7NY4.
The fiscal stress which many U.S. cities are currently experiencing, the persistent problems of large-city local government hospitals, the recent decisions for selected public hospital closings in New York City and Philadelphia, and the prospective enactment of a program of national health insurance collectively raise questions about the viability of the nation's major municipal hospitals. While the majority of the nation's 40 largest cities are in a state of economic and demographic decline, the diversity which characterizes their fiscal conditions and their responses to fiscal stress suggests caution in generalizing from the highly publicized New York City experience in asserting the ability of cities to continue to maintain public hospital activities. Indeed, there is considerable evidence to indicate that the staying power of municipal hospitals is quite substantial even in circumstances of severe fiscal stress. Further, analysis of the effect of Medicaid implementation on municipal hospital utilization and of the impact of prospective national health insurance programs on the demand for and supply of medical services suggests that municipal hospitals will continue to be important providers of health care services for many years to come.
许多美国城市目前正在经历的财政压力、大城市地方政府医院长期存在的问题、纽约市和费城近期关于部分公立医院关闭的决定，以及即将颁布的国家医疗保险计划，共同引发了有关美国主要城市医院生存能力的问题。虽然美国40个最大城市中的大多数正处于经济和人口衰退状态，但它们财政状况的多样性以及对财政压力的应对方式表明，不能仅仅根据备受关注的纽约市经验就一概而论地断言城市有能力继续维持公立医院的运营。事实上，有大量证据表明，即使在财政压力严重的情况下，城市医院的持久力依然相当可观。此外，对医疗补助计划实施对城市医院利用率的影响以及未来国家医疗保险计划对医疗服务供需的影响进行分析后发现，城市医院在未来许多年仍将是重要的医疗服务提供者。
