Martin S, Rice N, Smith P C
Department of Economics and Related Studies, University of York, U.K.
Soc Sci Med. 1998 Nov;47(10):1547-54. doi: 10.1016/s0277-9536(98)00231-7.
For most individuals, the use made of health care in a given year is determined principally by unpredictable random incidents. Of course, some individuals have a predictably higher predisposition to illness than others. However, the general consensus is that only a fraction of individual variability in health care costs can be predicted. The purpose of this paper is to explore the implications of this inherent randomness for setting health care budgets for general practitioner purchasers of health care. The paper argues that variability in utilization in health care is very high: that no capitation formula can ever completely capture that variability, even for large populations: that the variability may give rise to certain dysfunctional consequences if not managed carefully; and that therefore careful attention should be given to the managerial arrangements associated with any devolution of health care budgets.
对于大多数人来说，某一年中医疗保健的使用情况主要由不可预测的随机事件决定。当然，一些人比其他人更容易患病，这是可以预见的。然而，普遍的共识是，医疗保健成本中只有一小部分个体差异是可以预测的。本文的目的是探讨这种内在随机性对为医疗保健的全科医生购买者设定医疗保健预算的影响。本文认为，医疗保健使用情况的变异性非常高：即使对于大量人群，任何人均预算公式都无法完全捕捉到这种变异性；如果管理不善，这种变异性可能会导致某些功能失调的后果；因此，应仔细关注与医疗保健预算下放相关的管理安排。
