Frank R G, Goldman H H, McGuire T G
Harvard Medical School, Boston, Massachusetts 02115.
Hosp Community Psychiatry. 1994 Sep;45(9):906-10. doi: 10.1176/ps.45.9.906.
Current health care reform proposals will expand coverage and alter the delivery of mental health services. Much of the debate has focused on the cost of coverage rather than on the question "Who will pay?" This paper analyzes the consequences of redistribution of the financial burden of care. The analysis reveals two concerns. First, current employer-based proposals are somewhat regressive because premium costs fall disproportionately on lower-income workers. Second, the increase in federal government subsidies may lead to a significant decline in state and local government financing for mental health services. Both of these concerns have been partly addressed in reform proposals, but there are political barriers to more progressive, non-employer-based approaches and to strategies to retain state and local dollars for mental health services. These distributional issues are critical for a mental health system serving the poor and depending so heavily on state and local resources.
当前的医疗保健改革提案将扩大覆盖面并改变心理健康服务的提供方式。大部分辩论都集中在保险覆盖成本上，而非“谁来支付？”这个问题。本文分析了护理经济负担再分配的后果。分析揭示了两个问题。首先，当前基于雇主的提案在某种程度上具有累退性，因为保费成本不成比例地落在低收入工人身上。其次，联邦政府补贴的增加可能导致州和地方政府用于心理健康服务的资金大幅下降。改革提案已部分解决了这两个问题，但对于更进步的、非基于雇主的方法以及保留州和地方用于心理健康服务资金的策略，存在政治障碍。这些分配问题对于服务穷人且严重依赖州和地方资源的心理健康系统至关重要。
