Garber A M, Romer P M
Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA.
Proc Natl Acad Sci U S A. 1996 Nov 12;93(23):12717-24. doi: 10.1073/pnas.93.23.12717.
This paper considers the appropriate role for government in the support of scientific and technological progress in health care; the information the federal government needs to make well-informed decisions about its role; and the ways that federal policy toward research and development should respond to scientific advances, technology trends, and changes in the political and social environment. The principal justification for government support of research rests upon economic characteristics that lead private markets to provide inappropriate levels of research support or to supply inappropriate quantities of the products that result from research. The federal government has two basic tools for dealing with these problems: direct subsidies for research and strengthened property rights that can increase the revenues that companies receive for the products that result from research. In the coming years, the delivery system for health care will continue to undergo dramatic changes, new research opportunities will emerge at a rapid pace, and the pressure to limit discretionary federal spending will intensify. These forces make it increasingly important to improve the measurement of the costs and benefits of research and to recognize the tradeoffs among alternative policies for promoting innovation in health care.
本文探讨了政府在支持医疗保健领域科技进步方面的适当作用；联邦政府为就其作用做出明智决策所需的信息；以及联邦政府对研发的政策应如何应对科学进步、技术趋势以及政治和社会环境变化的方式。政府支持研究的主要理由基于经济特征，这些特征导致私人市场提供的研究支持水平不当，或提供的研究成果产品数量不当。联邦政府有两种处理这些问题的基本工具：对研究的直接补贴以及强化产权，这可以增加公司从研究成果产品中获得的收入。在未来几年，医疗保健提供系统将继续经历巨大变化，新的研究机会将迅速涌现，限制联邦自由裁量支出的压力也将加剧。这些力量使得改进对研究成本和效益的衡量以及认识到促进医疗保健创新的替代政策之间的权衡变得越来越重要。
