Miller R H, Luft H S
Institute for Health and Aging, University of California, San Francisco 94109.
JAMA. 1995 Feb 22;273(8):656-62.
The estimated impact of health system reform proposals on health expenditures influences the health system reform debate. Health expenditure growth rate (HEGR) estimates are particularly critical because small differences in rates over time create large differences in health expenditures. There currently is no hard scientific basis for estimating the impact of managed care/managed competition legislation and market developments on the HEGR. For the 1994 health system reform debate, the two leading nonpartisan modelers developed qualitative scenarios about future health system developments in which managed care/managed competition would have little or no impact on the HEGR. We conclude that there are alternative plausible scenarios, based on current health system changes interacting with potential legislation, in which managed care/managed competition will substantially lower the HEGR. We recommend that simulation models should provide a range of estimates that better reflect both market trends and the profound uncertainty about the effects of health system reform.
卫生系统改革提议对卫生支出的预估影响着卫生系统改革的辩论。卫生支出增长率（HEGR）的预估尤为关键，因为随着时间推移，增长率的细微差异会导致卫生支出出现巨大差异。目前，对于估算管理式医疗/管理式竞争立法及市场发展对卫生支出增长率的影响，尚无确凿的科学依据。在1994年的卫生系统改革辩论中，两位主要的无党派建模者针对未来卫生系统发展制定了定性情景，其中管理式医疗/管理式竞争对卫生支出增长率几乎没有影响。我们得出结论，基于当前卫生系统变化与潜在立法的相互作用，存在其他合理情景，在这些情景中，管理式医疗/管理式竞争将大幅降低卫生支出增长率。我们建议，模拟模型应提供一系列预估，以更好地反映市场趋势以及卫生系统改革效果的巨大不确定性。
