Goold S D
University of Michigan-Ann Arbor, USA.
J Health Polit Policy Law. 1998 Aug;23(4):687-95. doi: 10.1215/03616878-23-4-687.
In response to three articles on managed care by Allen Buchanan, David Mechanic, and Ezekiel Emanual and Lee Goldman (this issue), I discuss doctor-patient and organization-member trust and the moral obligations of those relationships. Trust in managed care organizations (providers of and payers for health care) stands in stark contrast to the current contractual model of health insurance purchase, but is more coherent with consumer expectations and with the provider role of such organizations. Such trust is likely to differ from that between doctors and patients. Financial reimbursement systems for physicians, one example of organizational change in our health system, can be evaluated for their impact on both kinds of trust according to their intrusiveness, openness, and goals. Although involving managed care enrollees in value-laden decisions that affect them is commendable, restrictions on or regulation of physician incentive systems may be better accomplished on a national level.
针对艾伦·布坎南、大卫·梅CHANIC、伊齐基尔·伊曼纽尔和李·戈德曼（本期）关于管理式医疗的三篇文章，我讨论了医患信任和组织成员信任以及这些关系中的道德义务。对管理式医疗组织（医疗保健提供者和支付者）的信任与当前医疗保险购买的合同模式形成鲜明对比，但更符合消费者期望以及此类组织的提供者角色。这种信任可能与医患之间的信任有所不同。医生的财务报销系统是我们医疗系统中组织变革的一个例子，可以根据其侵扰性、开放性和目标来评估其对这两种信任的影响。虽然让管理式医疗参保者参与影响他们的价值负载决策值得称赞，但对医生激励系统的限制或监管可能在国家层面上能更好地实现。
