Luft H S
Institute for Health Policy Studies, University of California, San Francisco, USA.
Health Aff (Millwood). 1996 Spring;15(1):23-38. doi: 10.1377/hlthaff.15.1.23.
California's health care marketplace is undergoing rapid transformation--from one characterized by aggressive but unregulated competition to one that approximates managed competition. The Pacific Business Group on Health purchases health insurance for large employers; the California Public Employees Retirement System acts as a purchasing pool for both state workers and smaller public employers; and The Health Insurance Plan of California is a pool for small employers. Each focuses on price-conscious competition among health maintenance organizations. These large purchasing cooperatives also are addressing biased selection among the health plans they offer. Initially focused on simple demographic adjustments, risk adjustment now also entails adjustment for high-risk cases, such as acquired immunodeficiency syndrome (AIDS) and liver transplants. These purchasers also devote more detailed attention to the quality and process of care.
加利福尼亚州的医疗保健市场正在经历快速转型——从一个以激烈但无监管的竞争为特征的市场，转变为一个近似管理型竞争的市场。太平洋商业健康集团为大型雇主购买医疗保险；加利福尼亚州公共雇员退休系统为州政府工作人员和较小的公共雇主充当采购池；而加利福尼亚健康保险计划则是小型雇主的采购池。每个机构都专注于健康维护组织之间注重价格的竞争。这些大型采购合作社也在解决它们所提供的健康计划中的偏向性选择问题。风险调整最初侧重于简单的人口统计学调整，现在还包括对高风险病例的调整，如获得性免疫缺陷综合征（艾滋病）和肝脏移植。这些采购方还更加详细地关注医疗质量和流程。
