Snoke A W
Am J Public Health. 1982 Sep;72(9):1028-33. doi: 10.2105/ajph.72.9.1028.
Health and welfare programs continue to be developed and implemented on a piecemeal basis in this country. There is difficulty in recognizing not only that health and social affairs are intimately related, but that the system must be dealt with as a whole of its interrelated problems are to be solved. Increasing costs for health and social programs are becoming of even greater concern, and cost containment (voluntary or regulatory) preoccupies both the payers and the recipients. Complicating the current situation is uncertainty of the role of financing and regulation on the part of the federal government and the states (the New Federalism), and the fragmentation and uncertainty of the private delivery sector and its third party reimbursement agencies. Questions are raised as to whether viable solutions can be obtained until all components (governmental and private) can work together in a partnership rather than an adversarial relationship in the development of an overall strategy with understandable objectives. Of basic importance is consideration of matters of organization, administration, and leadership at all levels so that whatever program may be developed or evolved can be successfully implemented. The subject is of such magnitude and is so complicated that it deserves a major coordinated effort of the federal government, the state governments, and the diverse private sector components to ensure a coordinated and systematic approach to any realistic solution.
在这个国家，健康与福利项目仍在零敲碎打地不断发展和实施。不仅难以认识到健康与社会事务紧密相关，而且若要解决其相互关联的问题，整个系统必须作为一个整体来处理。健康和社会项目成本不断增加，这一问题愈发受到关注，成本控制（自愿或监管）成为支付方和受益方共同关心的问题。当前形势的复杂之处在于，联邦政府和各州（新联邦主义）在融资和监管方面的角色存在不确定性，以及私营服务提供部门及其第三方报销机构的碎片化和不确定性。有人质疑，在所有组成部分（政府和私营部门）能够以合作伙伴关系而非对抗关系共同制定具有明确目标的总体战略之前，是否能够找到可行的解决方案。至关重要的是要考虑各级的组织、管理和领导问题，以便无论制定或发展何种项目都能成功实施。这个问题规模巨大且极其复杂，值得联邦政府、州政府和多元的私营部门组成部分做出重大协调努力，以确保采取协调一致且系统的方法来寻求任何切实可行的解决方案。
