Reilly B J, Fuhr J P
Soc Sci Med. 1983;17(12):795-801. doi: 10.1016/0277-9536(83)90030-8.
This article contends that competition advocates have treated the public market as peripheral to the development of a private allocative efficient market based on price determinations. A system which omits 40% of distributive resources, 30% of its users and over 50% of hospital revenues sets the stage for cost/charge spirals that promote greater inefficiencies than those which presently exist. The government in the sixties set a goal of universal quality service for medical care. However, this goal has not been achieved and the sky-rocketing cost for medical care is putting an increasing burden on the government. The authors attempt to provide a basis for the incorporation of the concept of the mixed market through a definition of public and private reimbursement systems. The public sector, rather than paying directly for care, purchases it in an efficient market which it helps to form. The government working with other health insurance companies in the private market attempts to set reasonable charges for reimbursement for medical services. Any price above the competitive level will be paid directly by the consumer. However, quality care is guaranteed to the consumer at the reasonable charge by insurance company referred physicians.
本文认为，竞争倡导者将公共市场视为基于价格决定的私人配置效率市场发展的外围因素。一个遗漏了40%的分配资源、30%的用户以及超过50%医院收入的系统，为成本/收费螺旋式上升创造了条件，这种螺旋式上升导致的低效率比当前存在的情况更为严重。20世纪60年代，政府设定了医疗服务普及优质服务的目标。然而，这一目标尚未实现，医疗费用的飙升给政府带来了越来越沉重的负担。作者试图通过对公共和私人报销系统的定义，为纳入混合市场概念提供一个基础。公共部门不是直接支付医疗费用，而是在它帮助形成的有效市场中购买医疗服务。政府与私人市场中的其他健康保险公司合作，试图为医疗服务报销设定合理的费用。任何高于竞争水平的价格将由消费者直接支付。然而，保险公司推荐的医生会以合理的费用为消费者保证提供优质医疗服务。
