Kivlahan C H, Land G H
Department of Family and Community Medicine, University of Missouri Hospitals and Clinics, University of Missouri-Columbia, 65212, USA.
Am J Prev Med. 1998 Apr;14(3 Suppl):72-7. doi: 10.1016/s0749-3797(97)00050-0.
As managed care radically changes the medical care environment, public health leaders are under increasing pressure to focus more on core public health functions and less on personal health services. As public health re-evaluates its key strategies, it can take advantage of its strategic role in purchasing medical care to forge new partnerships that benefit its constituents.
Specific roles for public health in medical care purchasing are discussed. The state of Missouri is used as an example of successful strategies for positioning public health as a leader in the managed care environment. Key strategies include increasing influence in contracting; selecting and reporting of key health status indicators; promoting use of population-based data files; taking leadership roles in government-sponsored insurance programs; and assuring stability of critical health conditions during managed care transitions.
Public health has unprecedented opportunities to develop new methods for improving health status. Public health's well-developed scientific principles and methods, combined with strategic leadership, will position the discipline in the forefront of the dialogue about our nation's health system into the next century.
随着管理式医疗彻底改变医疗环境，公共卫生领域的领导者面临着越来越大的压力，需要更多地关注核心公共卫生职能，而减少对个人健康服务的关注。在公共卫生重新评估其关键战略时，它可以利用其在购买医疗服务方面的战略作用，建立新的伙伴关系，使其选民受益。
讨论了公共卫生在医疗服务购买中的具体作用。以密苏里州为例，说明将公共卫生定位为管理式医疗环境中的领导者的成功策略。关键策略包括增强在合同签订方面的影响力；选择和报告关键健康状况指标；促进使用基于人群的数据文件；在政府资助的保险计划中发挥领导作用；以及在管理式医疗过渡期间确保关键健康状况的稳定性。
公共卫生拥有前所未有的机会来开发改善健康状况的新方法。公共卫生完善的科学原则和方法，加上战略领导力，将使该学科在下个世纪关于我国卫生系统的对话中处于前沿位置。
