Carpenter C E, Cornman J M, Bender A D, Nash D B
Widener University, Chester, PA 19013, USA.
J Eval Clin Pract. 1998 May;4(2):131-9. doi: 10.1111/j.1365-2753.1998.tb00079.x.
Debates over health reform in the United States are hampered by a poorly informed public and misunderstandings about the concepts of quality, cost containment and their relationship to each other. This paper explores the nature and persistence of barriers to an informed public discussion of reform proposals. Those barriers are: (1) multiple definitions of quality, cost and cost containment, (2) the impact of the media on those definitions, (3) a false assumption that cost containment automatically results in diminished quality, and (4) the perceived impact of managed care and for-profit health firms on that assumption. We suggest a framework for building the understanding and knowledge base necessary to a reform of the nation's health care system.
美国医疗改革辩论因公众信息不足以及对质量、成本控制概念及其相互关系的误解而受阻。本文探讨了阻碍就改革提案进行明智的公众讨论的障碍的性质和持续性。这些障碍包括：（1）质量、成本和成本控制的多种定义；（2）媒体对这些定义的影响；（3）认为成本控制会自动导致质量下降的错误假设；以及（4）人们认为管理式医疗和营利性医疗公司对该假设的影响。我们提出了一个框架，以建立对国家医疗保健系统改革所必需的理解和知识库。
