Swartz K, Brennan T A
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA.
Ann Intern Med. 1996 Feb 15;124(4):442-8. doi: 10.7326/0003-4819-124-4-199602150-00009.
Concerns about the effect of managed care techniques on the quality of medical care have been raised in many quarters. Physicians have advocated the reiteration of professional ethics or even the prohibition of market incentives in health care as solutions to the problem of cost-quality tradeoffs in managed care systems. However, few recognize the existing systems for the regulation of managed care or consider how additional regulation could alleviate some of the potential problems posed by market-based competition. We review the evolution and growth of managed care organizations and the payment techniques that could cause a conflict between patient welfare and physician income. We then discuss the existing types of federal and state regulation of managed care and suggest some new incentives that could buttress the ethical practice of medicine in the medical marketplace.
许多方面都对管理式医疗技术对医疗质量的影响表示担忧。医生们主张重申职业道德，甚至禁止医疗保健中的市场激励措施，以此作为解决管理式医疗系统中成本与质量权衡问题的办法。然而，很少有人认识到现有的管理式医疗监管体系，也很少有人考虑额外的监管如何能够缓解基于市场的竞争所带来的一些潜在问题。我们回顾了管理式医疗组织的演变与发展，以及可能导致患者福利与医生收入之间冲突的支付技术。然后，我们讨论了现有的联邦和州对管理式医疗的监管类型，并提出了一些新的激励措施，这些措施可以支持医疗市场中的道德医疗行为。
