Perneger T V, Etter J F, Gaspoz J M, Raetzo M A, Schaller P
Institut de médecine sociale et préventive, Université de Genève.
Soz Praventivmed. 1996;41(1):47-57. doi: 10.1007/BF01358846.
Health care organizations similar to American HMOs have recently appeared in Switzerland. They elicit many reactions, both in the general public and among the medical profession. In contrast to traditional health insurance, HMOs organize and actively manage health care delivered to their members. This paper reviews the historical background of similar organizations in Europe and in the United States, and focuses in particular on the recent evolution and fragmentation of the concept of "managed care". Follows a discussion of the mechanisms and the side-effects of various tools used to manage care, both in managed care settings and by traditional health insurance plans. It appears that all of health care is managed, that all management tools have potential side effects, and that use of some management tools implies a redistribution of the respective roles of plan members, administrators, and physicians. The authors suggest that the complexity of health care management requires a more active implication of the health professions in that process.
类似于美国健康维护组织（HMO）的医疗保健机构最近在瑞士出现了。它们在普通公众和医学界都引发了许多反应。与传统医疗保险不同，健康维护组织组织并积极管理提供给其成员的医疗保健服务。本文回顾了欧洲和美国类似组织的历史背景，并特别关注“管理式医疗”概念最近的演变和分化。接着讨论了在管理式医疗环境以及传统医疗保险计划中用于管理医疗的各种工具的机制和副作用。似乎所有医疗保健都是被管理的，所有管理工具都有潜在的副作用，并且使用某些管理工具意味着计划成员、管理人员和医生各自角色的重新分配。作者们建议，医疗保健管理的复杂性要求医疗行业在这一过程中更积极地参与。
