Rogal D L, Gauthier A K, Barrand N L
Alpha Center, Washington, DC 20036.
Inquiry. 1993 Fall;30(3):318-27.
There is ongoing debate as to whether global budgets, or expenditure limits, are compatible with a strategy for managed competition. The Robert Wood Johnson Foundation sponsored an invitational conference for public and private policymakers to discuss the issue. The meeting's purpose was to explore how global expenditure limits might work and what their implications would be for costs, access, and quality of health care. This article summarizes the ideas presented at the conference, looking in particular at global expenditure limit models in Germany and Canada. Overall, the papers and presentations at this meeting demonstrated that global expenditure limits have the potential to provide the necessary fiscal discipline to manage the health care system and provide a greater degree of certainty and accountability for payers, providers, and patients. However, it is also clear that without a common set of principles about the role health care should play in our society and an agreed upon framework of governance for the system, it will be difficult for the United States to resolve the detailed and complex implementation and administration issues of a reformed health care system.
关于全球预算或支出限制是否与管理式竞争战略相兼容，目前仍存在争议。罗伯特·伍德·约翰逊基金会为公共和私人政策制定者主办了一次邀请会议来讨论这个问题。会议的目的是探讨全球支出限制如何发挥作用，以及它们对医疗保健成本、可及性和质量会有什么影响。本文总结了会议上提出的观点，特别关注德国和加拿大的全球支出限制模式。总体而言，本次会议的论文和报告表明，全球支出限制有潜力提供必要的财政纪律来管理医疗保健系统，并为支付方、提供者和患者提供更大程度的确定性和问责制。然而，同样明显的是，如果没有一套关于医疗保健在我们社会中应发挥的作用的共同原则，以及一个各方商定的系统治理框架，美国将难以解决改革后的医疗保健系统的详细而复杂的实施和管理问题。
