Coughlin T A, Ku L, Holahan J, Heslam D, Winterbottom C
J Health Polit Policy Law. 1994 Winter;19(4):837-64. doi: 10.1215/03616878-19-4-837.
In recent years the growth of Medicaid spending has been a serious state budgetary problem. Between 1988 and 1992, state Medicaid expenditures increased at an average annual rate of 21 percent. Even when accounting for funds from special revenue programs, such as provider tax and donation programs, state Medicaid spending increased by 16 percent each year between 1988 and 1992, which is far higher than in previous years. This rapid expenditure growth occurred when states were having economic slowdowns and facing fiscal pressures in many other areas. Using a case study approach, we investigated the strategies used by nine states to address the recent surge in Medicaid spending. Despite fiscal pressures, the states generally avoided large-scale cutbacks in Medicaid. Instead they implemented a wide range of budgetary actions to reduce the effect of Medicaid growth, including increment program cutbacks, constraining other budgetary sectors, shifting program costs to the federal government, and raising state taxes.
近年来，医疗补助计划支出的增长已成为一个严重的州预算问题。1988年至1992年间，各州医疗补助计划支出的年平均增长率为21%。即使将来自特殊收入项目（如提供者税收和捐赠项目）的资金计算在内，1988年至1992年间各州医疗补助计划支出每年仍增长16%，这远远高于前几年。这种快速的支出增长发生在各州经济放缓且在许多其他领域面临财政压力之时。我们采用案例研究方法，调查了九个州为应对近期医疗补助计划支出激增所采用的策略。尽管面临财政压力，这些州总体上避免了大幅削减医疗补助计划。相反，它们采取了一系列预算行动来减轻医疗补助计划增长的影响，包括逐步削减项目、限制其他预算部门、将项目成本转嫁给联邦政府以及提高州税收。
