Miller R H
University of California, San Francisco, USA.
Health Aff (Millwood). 1996 Summer;15(2):92-106. doi: 10.1377/hlthaff.15.2.92.
The creation of integrated firms and contractual networks in health care often is a precondition for other forms of integration that could actually lower costs and improve quality of care. Although different types of integration activities are leading to innovations in the production of services and the care of populations, the continued influence of the "old" indemnity insurance/fee-for-service system creates important obstacles to those integration activities. If creation of integrated firms and contractual networks races ahead of other forms of integration, it could produce uncompetitive markets that reduce pressures to integrate in ways that can cut costs and improve quality of care. Purchasers' actions could play a major role in determining the future of various integration activities.
医疗保健领域中综合企业和契约网络的创建往往是其他形式整合的先决条件，而这些整合形式实际上能够降低成本并提高医疗质量。尽管不同类型的整合活动正在推动服务生产和人群护理方面的创新，但“旧”的赔偿保险/按服务收费系统的持续影响给这些整合活动带来了重大障碍。如果综合企业和契约网络的创建领先于其他形式的整合，可能会产生缺乏竞争力的市场，从而减少以降低成本和提高医疗质量的方式进行整合的压力。购买者的行动在决定各种整合活动的未来方面可能发挥主要作用。
