Saltman R B, Young D W
J Health Polit Policy Law. 1981 Fall;6(3):391-418. doi: 10.1215/03616878-6-3-391.
In-patient hospital costs have grown at an annual rate of 15 percent for the last fifteen years, and the cumulative impact of these increases has created tremendous political pressure to contain this growth. Yet despite numerous attempts to pinpoint the causes of this inflation-and nearly as many recommended policy approaches-the outlines of an effective cost containment program still elude us. Previous approaches to cost containment have tended to emphasize the mechanics of how hospital costs are incurred rather than seeking to explain the underlying causal factors that generate these costs. This analytic focus appears to reflect the lack of a political theory of the hospital which can comprehend the unique character of the hospital's internal decision-making process. One suitable basis for such a theory is Crozier's model of a "conflictive equilibrium." In this model, the hospital's decision-making authority is lodged in a complex power relationship which reflects the respective intra- and extra- institutional resources of its occupational groups, and particularly of physicians and administrators. This analysis of hospital behavior can both explain the hospital's reaction to present cost containment program as well as predict its response to other likely policy approaches. It also may enable us to begin to design more effective programs through which to control the financial consequences of hospital decisions.
在过去的十五年里，住院医院费用以每年15%的速度增长，这些增长的累积影响产生了巨大的政治压力，要求控制这种增长。然而，尽管人们多次试图找出这种通货膨胀的原因——以及几乎同样多的推荐政策方法——但有效的成本控制计划的轮廓仍然让我们捉摸不透。以前的成本控制方法往往强调医院成本产生的机制，而不是试图解释产生这些成本的潜在因果因素。这种分析重点似乎反映了缺乏一种能够理解医院内部决策过程独特性质的医院政治理论。这样一种理论的一个合适基础是克罗齐尔的“冲突性均衡”模型。在这个模型中，医院的决策权存在于一种复杂的权力关系中，这种关系反映了其职业群体，特别是医生和管理人员各自的内部和外部机构资源。这种对医院行为的分析既可以解释医院对当前成本控制计划的反应，也可以预测其对其他可能政策方法的反应。它还可能使我们开始设计更有效的计划，通过这些计划来控制医院决策的财务后果。
