Universal health insurance through incentives reform.
Universal health insurance through incentives reform.
复制标题
通过激励改革实现全民健康保险。
DOI：
10.1001/jama.1991.03460190110030
复制
发表时间：
1991
期刊：
影响因子：
--
通讯作者：
Richard Kronick
中科院分区：
文献类型：
--
作者：
A. Enthoven;Richard Kronick
大约 3500 万美国人没有医疗保险。医疗保健支出失控。获取问题和成本问题是密不可分的。重要的可纠正原因包括无成本意识的需求、没有为质量和经济而组织的系统、市场失灵以及公共资金没有公平或有效地分配以促进广泛的覆盖。我们建议公共赞助机构向那些没有保险的人提供补贴，强制雇主提供健康保险，所有雇主和雇员缴纳保费，限制雇主对雇员健康保险的免税缴款，以及“管理竞争”。我们提议的新政府收入等于提议的新支出。我们相信我们的建议将会奏效，因为高效的管理式医疗确实存在，并且可以以远低于传统按服务付费的第三方支付系统的成本提供令人满意的护理。如果有机会做出对经济负责的选择，人们会选择物有所值；这些个人选择所产生的动力将给予提供者强有力的激励，以提供高质量、经济的护理。我们相信提供商会对这些激励措施做出反应。
Roughly 35 million Americans have no health care coverage. Health care expenditures are out of control. The problems of access and cost are inextricably related. Important correctable causes include cost-unconscious demand, a system not organized for quality and economy, market failure, and public funds not distributed equitably or effectively to motivate widespread coverage. We propose Public Sponsor agencies to offer subsidized coverage to those otherwise uninsured, mandated employer-provided health insurance, premium contributions from all employers and employees, a limit on tax-free employer contributions to employee health insurance, and "managed competition". Our proposed new government revenues equal proposed new outlays. We believe our proposal will work because efficient managed care does exist and can provide satisfactory care for a cost far below that of the traditional fee-for-service third-party payment system. Presented with an opportunity to make an economically responsible choice, people choose value for money; the dynamic created by these individual choices will give providers strong incentives to render high-quality, economical care. We believe that providers will respond to these incentives.