Caring for the uninsured in Massachusetts.
Caring for the uninsured in Massachusetts.
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照顾马萨诸塞州没有保险的人。
DOI：
10.1080/00185869809596487
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发表时间：
1998
期刊：
影响因子：
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通讯作者：
M. O’sullivan
中科院分区：
文献类型：
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作者：
M. O’sullivan
竞争和成本控制措施给马萨诸塞州等州提供的安全网带来了巨大压力，这些州为没有保险或没有足够私人保险的人支付医院护理费用。马萨诸塞州的这个项目被称为“无补偿医疗池”，它向医院报销向没有保险或保险不足的低收入患者提供医疗服务的费用。医院按其从私营部门和第三方支付者那里获得的收入的比例捐款，为该资金池提供资金。然而，医院收到的信息好坏参半。一方面，他们的传统使命、税法的结构以及来自穷人权益倡导者的政治压力，使人们对没有医疗保险或保险范围不足的人免费获得基本医疗保健服务抱有很高的期望。另一方面，竞争激烈的市场迫使医院、保险公司和雇主提高经营利润率，消除不必要的成本。雇主要求降低医疗保险费，这意味着提供无偿医疗的成本不能轻易转移到医疗保险公司和hmo身上。与此同时，医疗保险公司和hmo对折扣或资本化费率的要求意味着医院自己无法轻易承担成本。此外，传统的
Competition and cost containment efforts are putting great strain on the safety net provided by states such as Massachusetts, which pay for the hospital care ofpeople who are uninsured or who have inadequate private insurance. Known as the uncompensated care pool, the Massachusetts program reimburses hospitals for the cost of care provided to uninsured or underinsured low-income patients. Hospitals fund the pool by making contributions in proportion to their revenue from private-sector, third-party payers. However, hospitals are receiving mixed messages. On the one hand, their traditional mission, the structure of tax laws, and political pressure from advocates for the poor create high expectations that essential healthcare services will be provided at no charge for those without health insurance or who have inadequate coverage. On the other hand, the competitive marketplace pressures hospitals, insurers, and employers to increase operating margins and eliminate unnecessary costs. Employers' demands for lower health insurance premiums mean that the costs of furnishing uncompensated care cannot easily be shifted to health insurers and HMOs. At the same time, the demand for discounted or capitated rates by health insurers and HMOs means hospitals cannot easily absorb the costs themselves. In addition, the tradi-