Marmor T, Oberlander J
Health Aff (Millwood). 1998 Jan-Feb;17(1):52-68. doi: 10.1377/hlthaff.17.1.52.
Many health policy analysts argue that demographic pressures, the inflationary nature of fee-for-service payment, and the uncontrollable nature of defined-benefit insurance make Medicare unsustainable in its current form. They assert that Medicare can remain fiscally viable in the next century only by embracing a voucher system and exposing beneficiaries to the economic consequences of their medical care decisions. We argue here, however, that Medicare need not rely on vouchers or on placing financial incentives on individual beneficiaries to control costs. Instead, we contend that Medicare can control expenditures the way most other industrial democracies do: through budgetary caps and centralized regulation of provider payments.
许多卫生政策分析人士认为，人口压力、按服务收费支付方式的通胀性质以及固定收益保险的不可控性，使得现行形式的医疗保险难以持续。他们断言，医疗保险只有通过采用代金券制度并让受益人承担其医疗决策的经济后果，才能在下个世纪保持财政上的可行性。然而，我们在此认为，医疗保险无需依赖代金券或对个别受益人施加经济激励来控制成本。相反，我们认为医疗保险可以像大多数其他工业民主国家那样控制支出：通过预算上限和对医疗服务提供者支付的集中监管。
