Eisenberg J M, Williams S V
JAMA. 1981 Nov 13;246(19):2195-201.
The important role of physicians in the generation of medical care costs is evident, but methods of inducing physicians to participate in cost-containment efforts are not well developed. Efforts to change physicians' use of medical services have included education, peer review and feedback, administrative changes, participation, penalties, and rewards. Although educational programs have had mixed success, those using individualized instruction have been most effective. Several feedback and peer-review programs have demonstrated reductions in costs, as have administrative interventions. While penalties and direct rewards may be effective, alterations in the current reimbursement system could offer financial incentives to physicians who practice in a cost-effective manner.
医生在医疗费用产生过程中所起的重要作用是显而易见的，但促使医生参与成本控制努力的方法却尚未得到充分发展。为改变医生对医疗服务的使用情况所做的努力包括教育、同行评审与反馈、行政变革、参与、惩罚和奖励。尽管教育项目的成效参差不齐，但采用个性化指导的项目最为有效。一些反馈和同行评审项目已证明能够降低成本，行政干预也有同样效果。虽然惩罚和直接奖励可能有效，但改变当前的报销系统可以为以具有成本效益方式行医的医生提供经济激励。
