Lowrie E G, Hampers C L
N Engl J Med. 1981 Aug 20;305(8):434-8. doi: 10.1056/NEJM198108203050805.
The 92nd Congress extended Medicare benefits to patients with end-stage renal disease (ESRD), sparing patients the financial burden of treating this catastrophic illness. The costs of the ESRD program have been contained better than those of health care generally; payment was originally limited by a screen of $138 per dialysis but could be higher if higher cost was documented. About 48 per cent of patients receive dialysis in units outside hospitals. The majority of these units are operated for profit, in which physicians share. The payment to these facilities has remained constant while payment to the nonprofit hospitals' unit has increased markedly. Physicians in for-profit units have a strong incentive to learn about costs and control them. They are involved in medical economic management as well as clinical management; this results in integrated administration of health care. The success of the ESRD program in expanding service to meet demand while controlling costs and maintaining quality has been due primarily to the combined effect of setting a price and creating a system of incentives that involves physicians in the medical marketplace.
第92届国会将医疗保险福利扩大到终末期肾病（ESRD）患者，使患者免于承担治疗这种灾难性疾病的经济负担。ESRD项目的成本控制得比一般医疗保健成本更好；最初每次透析的支付上限为138美元，但如果有更高成本的记录，支付金额可能会更高。约48%的患者在医院外的单位接受透析。这些单位中的大多数是营利性经营，医生也参与其中。对这些机构的支付保持不变，而非营利性医院的透析单位的支付则显著增加。营利性单位的医生有强烈的动机了解成本并加以控制。他们既参与医疗经济管理，也参与临床管理；这导致了医疗保健的综合管理。ESRD项目在扩大服务以满足需求的同时控制成本并维持质量方面取得成功，主要归功于设定价格以及创建一个激励体系的综合作用，该激励体系让医生参与到医疗市场中。
