Schwartz W B
N Engl J Med. 1981 Nov 19;305(21):1249-55. doi: 10.1056/NEJM198111193052104.
Three regulatory mechanisms have been used to control the rise in hospital costs: assessments of patients' records by professional standards review organizations (PSROs), approval of capital expenditures by certificate-of-need agencies, and limits on hospital reimbursement by state rate-setting groups. The available evidence indicates that neither PSROs nor certificate-of-need programs have exerted an appreciable influence on costs. However, rate setting through mandatory "prospective reimbursement" appears to slow the growth of hospital expenditures and seems to be the only regulatory tool that has been effective. Any regulatory process that markedly restrains expenditures can ultimately be expected to affect patient care adversely and to create social and political tension within the health-care system.
专业标准审查组织（PSROs）对患者记录进行评估、需求证明机构批准资本支出，以及州费率制定小组对医院报销进行限制。现有证据表明，PSROs和需求证明计划都未对成本产生显著影响。然而，通过强制性“预期报销”进行费率设定似乎减缓了医院支出的增长，并且似乎是唯一有效的监管工具。任何显著限制支出的监管过程最终都可能对患者护理产生不利影响，并在医疗保健系统内造成社会和政治紧张局势。
