Fairfield G, Hunter D J, Mechanic D, Rosleff F
Nuffield Institute for Health, University of Leeds.
BMJ. 1997 Jun 28;314(7098):1895-8. doi: 10.1136/bmj.314.7098.1895.
The rhetoric and realities of managed care are easily confused. The rapid growth of managed care in the United States has had many implications for patients, doctors, employers, state and federal programmes, the health insurance industry, major medical institutions, medical research, and vulnerable patient populations. It has restricted patients' choice of doctors and limited access to specialists, reduced the professional autonomy and earnings of doctors, shifted power from the non-profit to the for-profit sectors and from hospitals and doctors to private corporations. It has also raised issues about the future structuring and financing of medical education and research and about practice ethics. However, managed care has also accorded greater prominence to the assessment of patient satisfaction, profiling and monitoring of doctors' work, the use of clinical guidelines and quality assurance procedures and indicated the potential to improve the integration and outcome of care.
管理式医疗的言辞与现实很容易混淆。管理式医疗在美国的迅速发展对患者、医生、雇主、州和联邦项目、健康保险行业、大型医疗机构、医学研究以及弱势群体都产生了诸多影响。它限制了患者对医生的选择，减少了获得专科医生服务的机会，降低了医生的职业自主性和收入，将权力从非营利部门转移到了营利部门，从医院和医生转移到了私人公司。它还引发了关于医学教育和研究未来结构与资金筹措以及执业伦理的问题。然而，管理式医疗也更加重视患者满意度评估、医生工作的剖析与监测、临床指南和质量保证程序的使用，并显示出改善医疗整合与疗效的潜力。
