Soffel D, Luft H S
Institute for Health Policy Studies, UCSF School of Medicine 94109.
West J Med. 1993 Oct;159(4):494-500.
The current proliferation of proposals for health care reform makes it difficult to sort out the differences among plans and the likely outcome of different approaches to reform. The current health care system has two basic features. The first, enrollment and eligibility functions, includes how people get into the system and gain coverage for health care services. We describe 4 models, ranging from an individual, voluntary approach to a universal, tax-based model. The second, the provision of health care, includes how physician services are organized, how they are paid for, what mechanisms are in place for quality assurance, and the degree of organization and oversight of the health care system. We describe 7 models of the organization component, including the current fee-for-service system with no national health budget, managed care, salaried providers under a budget, and managed competition with and without a national health budget. These 2 components provide the building blocks for health care plans, presented as a matrix. We also evaluate several reform proposals by how they combine these 2 elements.
当前医疗保健改革提案的激增使得难以理清各计划之间的差异以及不同改革方法可能产生的结果。当前的医疗保健系统有两个基本特征。第一个是参保和资格认定功能，包括人们如何进入该系统以及获得医疗保健服务的覆盖范围。我们描述了4种模式，从个人自愿模式到基于税收的全民模式。第二个是医疗保健的提供，包括医师服务如何组织、如何支付费用、有哪些质量保证机制以及医疗保健系统的组织和监督程度。我们描述了组织部分的7种模式，包括当前没有国家医疗预算的按服务收费系统、管理式医疗、预算下的薪资制提供者以及有和没有国家医疗预算的管理竞争。这两个部分为以矩阵形式呈现的医疗保健计划提供了构建要素。我们还根据它们如何结合这两个要素来评估几项改革提案。
