Enthoven A C
Health Aff (Millwood). 1993;12 Suppl:24-48. doi: 10.1377/hlthaff.12.suppl_1.24.
Managed competition in health care is an idea that has evolved over two decades of research and refinement. It is defined as a purchasing strategy to obtain maximum value for consumers and employers, using rules for competition derived from microeconomic principles. A sponsor (either an employer, a governmental entity, or a purchasing cooperative), acting on behalf of a large group of subscribers, structures and adjusts the market to overcome attempts by insurers to avoid price competition. The sponsor establishes rules of equity, selects participating plans, manages the enrollment process, creates price-elastic demand, and manages risk selection. Managed competition is based on comprehensive care organizations that integrate financing and delivery. Prospects for its success are based on the success and potential of a number of high-quality, cost-effective, organized systems of care already in existence, especially prepaid group practices. As it is outlined here, managed competition as a means to reform the U.S. health care system is compatible with Americans' preferences for pluralism, individual choice and responsibility, and universal coverage.
医疗保健中的管理式竞争是一个经过二十多年研究和完善而发展起来的理念。它被定义为一种采购策略，利用从微观经济原则推导出来的竞争规则，为消费者和雇主获取最大价值。一个赞助者（雇主、政府实体或采购合作社）代表一大群订阅者行事，构建并调整市场，以克服保险公司避免价格竞争的企图。赞助者制定公平规则，选择参与计划，管理注册过程，创造价格弹性需求，并管理风险选择。管理式竞争基于整合融资和服务提供的综合护理组织。其成功的前景取决于现有的一些高质量、高性价比、有组织的护理系统的成功和潜力，特别是预付团体医疗模式。如此处所述，管理式竞争作为改革美国医疗保健系统的一种手段，与美国人对多元化、个人选择和责任以及全民覆盖的偏好相契合。
