Oliver T R
Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205-1999, USA.
Milbank Q. 1998;76(1):59-101. doi: 10.1111/1468-0009.00079.
One of the most dynamic areas of health policy is the transition of Medicaid programs to managed care and market competition. Maryland has been a leader in this trend, initiating three different systems of managed care for the Medicaid population during the 1990s as it searched for an ideal plan. The Maryland experience illustrates the complex new demands that policy makers are facing. Health plans are expected not only to deliver budgetary savings, but also to improve the quality of their services and guarantee a place for safety-net providers in their delivery systems. As a result, there is a sizable gap between the original savings projected for the new Maryland system and its actual capacity for cost containment. The apparent collision between economic assumptions and political realities, however, may point the way to a constructive synthesis--a form of managed care that balances economy with important community, professional, and personal values.
卫生政策最具活力的领域之一是医疗补助计划向管理式医疗和市场竞争的转变。马里兰州一直是这一趋势的引领者，在20世纪90年代为医疗补助人群启动了三种不同的管理式医疗系统，以寻求理想方案。马里兰州的经历说明了政策制定者面临的复杂新要求。人们期望健康计划不仅能节省预算，还能提高服务质量，并在其服务体系中为安全网提供者保留一席之地。因此，马里兰州新系统最初预计的节省费用与其实际控制成本的能力之间存在相当大的差距。然而，经济假设与政治现实之间明显的冲突可能为建设性的综合方案指明方向——一种平衡经济与重要的社区、专业和个人价值观的管理式医疗形式。
