Spitz B
Brandeis University, Institute for Health Policy, USA.
J Health Polit Policy Law. 1997 Aug;22(4):1021-50. doi: 10.1215/03616878-22-4-1021.
The pell-mell restructuring of health care into massive regional delivery systems has disrupted long-standing relationships between local leaders and residents and their community health care systems. This diminished role of communities in our new world of health care is ironic. As control within large regions in this country becomes concentrated within the operation of three or four health plans, we become increasingly dependent upon oligopolies for our market solutions. As economic arrangements, all that oligopolies can offer are indeterminate outcomes. Some may be good for consumers, others disastrous. Without the countervailing influence of nonmarket community interests, individuals may find their satisfaction with the health care system greatly diminished.
医疗保健被匆忙重组为大规模的区域提供系统，这破坏了地方领导人与居民及其社区医疗保健系统之间长期存在的关系。在我们新的医疗保健世界中，社区的这一角色削弱具有讽刺意味。随着这个国家的大片地区的控制权集中在三四个医疗计划的运营中，我们在市场解决方案方面越来越依赖寡头垄断。作为经济安排，寡头垄断所能提供的只是不确定的结果。有些可能对消费者有利，有些则是灾难性的。没有非市场社区利益的制衡影响，个人可能会发现他们对医疗保健系统的满意度大幅下降。
