Bradbury R C
Public Health Rep. 1983 Nov-Dec;98(6):609-15.
The experience of the Central Massachusetts Health Systems Agency (CMHSA) and the Central Massachusetts Business Group on Health (CMBGH) demonstrates the feasibility of cooperation between HSAs and BGHs. Objectives and strategies of the two groups in carrying out community health planning and working for health systems change are compared. Nearly two decades of government-sponsored community health planning programs, first through comprehensive health planning agencies and then through HSAs, have had less impact than many had anticipated because neither the technical nor political basis for such planning was sufficiently established. The CMHSA experience is typical, although it is credited with developing a hospital systems plan that is based on sound planning methods and statistical data. It is in the implementation of plans that the CMHSA has made slow progress, reflecting its inadequate community power base. The CMBGH, 1 of more than 90 groups that have developed recently across the country to attack high health care costs, was formed in 1981 by business leaders to address these rising costs. The principal strategy adopted by the CMBGH involves fostering a competitive health care market by creating a critical number of competing health plans. The providers in each plan will then have incentives to provide effective care in an efficient manner to keep the premium competitive and attract enrollees. Cooperation between the CMBGH and CMHSA is based on each organization's emphasizing its strengths. The CMHSA's data base and analyses have been the primary resources used by the CMBGH to identify problems. Each organization has developed its own set of goals and objectives, while keeping in mind those of the other organization. The CMBGH adopted a subset of theCMHSA's goals-those that focus on hospital capacity and utilization. Although the CMHSA's regulatory strategies differ greatly from the CMBGH's competition strategies, they do not necessarily conflict.Actually, each organization is supporting the other's strategies without deemphasizing its own.The CMBGH currently has a decisive advantage over the CMHSA in implementing activities because the business leaders are an integral part of the community power structure. Also, their companies' willingness to offer additional health plans to their employees is the prime incentive to develop such plans.
马萨诸塞州中部卫生系统机构（CMHSA）和马萨诸塞州中部商业健康组织（CMBGH）的经验证明了卫生系统机构与商业健康组织合作的可行性。比较了这两个组织在开展社区卫生规划和推动卫生系统变革方面的目标和策略。近二十年来，政府资助的社区卫生规划项目，先是通过综合卫生规划机构，然后是通过卫生系统机构，但实际影响比许多人预期的要小，因为此类规划的技术和政治基础都不够坚实。CMHSA的经历很典型，尽管它因制定了基于合理规划方法和统计数据的医院系统规划而受到赞誉。CMHSA在计划实施方面进展缓慢，这反映出其社区权力基础不足。CMBGH是全国最近成立的90多个旨在应对高医疗成本问题的组织之一，于1981年由商界领袖组建，以应对不断上涨的成本。CMBGH采取的主要策略是通过创建一定数量的相互竞争的健康计划来培育竞争性的医疗保健市场。每个计划中的提供者将因此有动力以高效方式提供有效的医疗服务，以保持保费具有竞争力并吸引参保者。CMBGH与CMHSA之间的合作基于每个组织对自身优势的强调。CMHSA的数据库和分析一直是CMBGH用以识别问题的主要资源。每个组织都制定了自己的一套目标，同时也牢记对方组织的目标。CMBGH采纳了CMHSA目标中的一部分——那些侧重于医院容量和利用率的目标。尽管CMHSA的监管策略与CMBGH的竞争策略有很大不同，但它们不一定相互冲突。实际上，每个组织都在支持对方的策略，同时也没有忽视自身的策略。目前，CMBGH在实施活动方面比CMHSA具有决定性优势，因为商界领袖是社区权力结构的重要组成部分。此外，他们的公司愿意为员工提供额外的健康计划，这是制定此类计划的主要动力。
