Weil T P
Bedford Health Associates, Asheville, NC 28801, USA.
Am J Emerg Med. 1996 Jan;14(1):74-8. doi: 10.1016/S0735-6757(96)90020-0.
Health reform is now predicted to occur in the marketplace without much further governmental intervention. The major vehicles driving this fortuitous trend are the managed care plans, capitated payment, and the development of complex and fiscally awesome health networks organized by hospitals, physicians, and health insurance companies. In the context of this procompetitive environment, potential decreases are projected in current emergency department (ED) volumes, demand for emergency medicine (EM) physicians, and anticipated workload and remuneration of doctors working in EDs. Eventually, mandated universal insurance for 260 million Americans will create a slight increase in total ED visits; additional cost constraints will force the closure of a number of hospital EDs; and EM specialists will experience less ideal working conditions, requiring them to work more hours to maintain their current incomes.
现在预计医疗改革将在市场上自然发生，无需政府过多干预。推动这一有利趋势的主要力量是管理式医疗计划、按人头付费，以及由医院、医生和健康保险公司组建的复杂且成本高昂的医疗网络的发展。在这种有利于竞争的环境下，预计当前急诊科（ED）的就诊量、对急诊医学（EM）医生的需求，以及急诊科医生预期的工作量和薪酬都将下降。最终，为2.6亿美国人强制实施全民保险将使急诊就诊总量略有增加；额外的成本限制将迫使一些医院急诊科关闭；急诊专科医生的工作条件将变得不那么理想，他们需要工作更长时间才能维持目前的收入。
