Weiner S M
Am J Law Med. 1980 Winter;5(4):331-41.
The American health care delivery system, and the attitude of the public toward that system, have undergone considerable change during the past two decades. According to the author, the belief during the 1960s that adequate funds were available to broaden access to health services, to enhance their quality and availability, and to support medical innovation, gave way during the 1970s to an awareness of limited resources, to a skepticism about the motives and competence of established institutions, and to a conviction that the system's problems were too complex to be solved easily, if at all. Moreover, the author states, the system has become fragmented and highly competitive; the respect formerly accorded both professionals and institutions has deteriorated; and the government's role in health care delivery is being challenged. The result, the author says, may well be a paralysis of policymaking in health planning, as exemplified by the failure of both public and private institutions to achieve the cost-containment goals of the last decade, either through regulation or competition. To gain perspective on these problems and to determine the direction of the health care delivery system for the 1980s, the author calls for a national health care debate. He suggests four concepts that should be included in such a debate, and recommends a new context of pragmatic idealism in which to conduct it.
在过去二十年里，美国的医疗保健服务体系以及公众对该体系的态度都发生了相当大的变化。据作者所言，20世纪60年代人们认为有足够的资金来扩大医疗服务的可及性、提高其质量和可得性以及支持医学创新，但到了70年代，这种观念让位于对资源有限的认识、对既有机构动机和能力的怀疑，以及一种认为该体系问题过于复杂以至于即便有可能也难以轻易解决的信念。此外，作者指出，该体系已变得分散且竞争激烈；以往给予专业人员和机构的尊重已有所下降；政府在医疗保健服务提供方面的作用正受到挑战。作者称，结果很可能是卫生规划中的决策陷入瘫痪，公共和私人机构在过去十年里无论是通过监管还是竞争都未能实现成本控制目标便是例证。为了正确看待这些问题并确定20世纪80年代医疗保健服务体系的发展方向，作者呼吁展开一场全国性的医疗保健辩论。他提出了这场辩论应包含的四个概念，并建议在一种务实理想主义的新背景下进行这场辩论。
