Weil T P
Bedford Health Associates Inc., Management Consultants for Health and Hospital Services, Asheville, NC 28801.
J Natl Med Assoc. 1993 Apr;85(4):257-63.
In the search for fairness of access to health care, value for the money spent, and high quality of patient care, the United States has vacillated between advocacy of government regulations (the 1970s) and of market-driven, pro-competitive (1980s) approaches. The possible enactment of President Clinton's health reform plan with a managed-care strategy (1990s) calls for paying physicians and other providers in a manner that often induces them to minimize the provision of services to patients per episode of illness. This article discusses the impact of such legislation on patients, physicians, and other providers. It then argues that the President's managed competition approach, which micromanages health-care services, will fail except by concurrently implementing his proposed National Health Board's global budgetary concept. The major reason is that health reform for the 36.6 million uninsured Americans, who are mostly the working poor and their dependents, is only practical and affordable if stringent policies are adopted that reorganize available health-care resources and simultaneously implement cost-containment constraints.
在寻求医疗保健的公平可及性、所花资金的价值以及高质量的患者护理的过程中，美国在倡导政府监管（20世纪70年代）和市场驱动、促进竞争（20世纪80年代）的方法之间摇摆不定。克林顿总统的带有管理式医疗策略的医疗改革计划（20世纪90年代）若有可能颁布，要求以一种常常促使医生和其他医疗服务提供者在每次疾病发作时尽量减少为患者提供服务的方式来支付他们的费用。本文讨论了此类立法对患者、医生和其他医疗服务提供者的影响。然后论证了总统的微观管理医疗服务的管理式竞争方法将会失败，除非同时实施他提议的国家卫生委员会的全球预算概念。主要原因是，对于3660万未参保的美国人（他们大多是在职贫困人口及其家属）来说，只有采取严格政策重新组织可用的医疗保健资源并同时实施成本控制限制，医疗改革才切实可行且负担得起。
