Schowalter J E
Yale Child Study Center, New Haven, Connecticut 06520-7900, USA.
Isr J Psychiatry Relat Sci. 1998;35(3):165-73; discussion 174-83.
In the 1990s the United States has, because of an unacceptable surge in health care costs, made a revolutionary shift of the reimbursement process from fee-for-service to managed care's restricted, discounted and capitated payment approaches. Mental health care has for 150 years largely been subsidized by tax supported hospitals and clinics. Federal and state governments have recently instead begun to direct much of their monies to for-profit national managed mental health care companies. While efficiency has improved and the steep rise in costs has been eased, the major drawback of this change is a too enthusiastic focus on corporate profits. Since on the whole managed care organizations do not reinvest profits into medical education or research and may pull out of the health care business once the business is no longer so profitable, clinicians and academicians must become more successful in urging politicians and the citizenry to better manage managed care.
20世纪90年代，由于医疗保健成本出现了令人无法接受的飙升，美国对报销流程进行了革命性转变，从按服务收费转向管理式医疗的受限、折扣和按人头付费方式。150年来，精神卫生保健在很大程度上一直由税收支持的医院和诊所提供补贴。相反，联邦和州政府最近开始将大部分资金投向营利性的全国性管理式精神卫生保健公司。虽然效率有所提高，成本的急剧上升也得到了缓解，但这一变化的主要缺点是过于热衷于追求企业利润。由于总体而言，管理式医疗组织不会将利润再投资于医学教育或研究，一旦业务不再那么有利可图，可能会退出医疗保健业务，临床医生和学者必须在敦促政治家和民众更好地管理管理式医疗方面更加成功。
