Carpenter E S, Paul-Shaheen P
J Health Polit Policy Law. 1984 Fall;9(3):453-73. doi: 10.1215/03616878-9-3-453.
This paper traces the implementation of Michigan's program for hospital bed reduction through four phases in the critical first 30 months following enactment: standard-setting, plan development, plan approval, and legislative oversight. Procedural complexity and goal conflict complicated implementation from the start: what began as a simple proposal to close unneeded beds soon became enmeshed in efforts to address long-standing issues of equity in access to care. A combination of administrative, political, and economic factors peculiar to Michigan, as well as the more generic problems incurred in applying a regulatory approach to containing medical care costs, contributed to the difficulties encountered in implementing bed reduction. Long-range prospects for the program depend upon whether the modest results it is likely to achieve are deemed to be worth the costs incurred in administering it.
本文追溯了密歇根州医院床位削减计划在法案颁布后的关键头30个月内分四个阶段的实施情况：标准制定、计划制定、计划批准和立法监督。程序的复杂性和目标冲突从一开始就使实施变得复杂：最初作为一项关闭不必要床位的简单提议，很快就卷入了解决长期存在的医疗服务可及性公平问题的努力中。密歇根州特有的行政、政治和经济因素，以及在采用监管方法控制医疗成本时出现的更普遍问题，导致了床位削减实施过程中遇到的困难。该计划的长期前景取决于其可能取得的适度成果是否被认为值得付出管理成本。
