Vladeck B C
Med Care. 1981 Dec;19(12 Suppl):69-80. doi: 10.1097/00005650-198112001-00007.
Access to health care services for the poor and elderly have improved dramatically over the last 15 years, largely as a result of Medicare, Medicaid, and other Federal initiatives. The poor now consume roughly the same volume of health services as the nonpoor. Yet there are still substantial access barriers for many of the chronically ill, minorities, and residents of inner cities and rural areas. Of broader concern, the improvements in access are now threatened by the response to rising health care costs. Those cost increases are themselves partly--but only partly--attributable to Medicare and Medicaid themselves. True cost containment, as opposed to program cost containment, can restrain cost increases without damaging access, but is politically more difficult to accomplish than measures to reduce access.
在过去15年里，贫困人群和老年人获得医疗保健服务的情况有了显著改善，这在很大程度上要归功于医疗保险、医疗补助和其他联邦举措。如今，贫困人口所消费的医疗服务量与非贫困人口大致相同。然而，对于许多慢性病患者、少数族裔以及城市中心和农村地区的居民来说，仍然存在巨大的就医障碍。更令人担忧的是，如今获得医疗服务情况的改善正受到应对医疗成本上升的影响的威胁。这些成本增加本身部分——但只是部分——可归因于医疗保险和医疗补助本身。与控制项目成本不同，真正的成本控制可以在不损害就医机会的情况下抑制成本增长，但在政治上比减少就医机会的措施更难实现。
