Grossman R M
Med Care. 1983 Aug;21(8):783-802. doi: 10.1097/00005650-198308000-00003.
Although there are large-scale forces that influence the economic behavior of the health care delivery system, it is the physician who has primary authority to make decisions about the use of resources. Consequently, when considering alternative options for controlling rising health care expenditures, it is useful to examine strategies that focus on promoting efficient physician practice habits. This article reviews the role of the physician as a contributor to the health care cost problem and the state of physician cost-control strategies relative to laboratory testing in confronting this national problem. Five intervention strategies in use are explored: 1) educational strategies intended to improve ordering behavior by increasing knowledge of clinical utilities of tests and procedures in relation to their costs, 2) feedback strategies to compare actual ordering behavior with ordering protocols, 3) cost-awareness strategies, 4) rationing strategies, and 5) market-oriented financial incentives and risk-sharing plans to prompt decreased utilization of diagnostic tests and procedures. Prospects for these strategies are discussed as well.
尽管存在影响医疗保健服务系统经济行为的大规模力量，但医生拥有决定资源使用的主要权力。因此，在考虑控制医疗保健费用不断上涨的替代方案时，研究侧重于促进医生高效执业习惯的策略是很有用的。本文回顾了医生在医疗保健成本问题中所起的作用，以及在应对这一全国性问题时，相对于实验室检测而言医生成本控制策略的现状。探讨了正在使用的五种干预策略：1）旨在通过增加对检测和程序临床效用与其成本关系的了解来改善医嘱行为的教育策略；2）将实际医嘱行为与医嘱规范进行比较的反馈策略；3）成本意识策略；4）配给策略；5）以市场为导向的财务激励措施和风险分担计划，以促使减少诊断检测和程序的使用。还讨论了这些策略的前景。
