AN ANALYSIS ON FUNCTIONS OF NONPROFIT ORGANIZATIONS IN HEALTH CARE SYSTEM OF USA

在这项研究中，我们报告说，许多非营利组织（NPO）在美国的医疗保健系统中发挥着重要作用。他们是美国卫生保健服务的主要提供者，是社区的安全卫士，是解决穷人、健康、卫生保健系统中存在的一些矛盾等问题的倡导者，而且美国卫生保健系统和非营利部门中有少数经济规模较大的组织和大量的基层小组织。这一部门具有经济上的双重性，这也反映了美国医疗保健系统中大小组织发挥的作用的差异。具体而言，组织规模对职业在组织中的作用有重要影响。也就是说，在大型组织中，专业人员只是填补了部门中有限的角色，或者作为专家促进了专业化。而在基层的小社区，他们不仅在整个活动中起着协调的作用，而且在社区的发展和满足社区的需要方面起着主要的作用，另一个结果是，如果没有政府的支持，他们就无法完成自己的使命。今天，随着管理式医疗在全国范围内的普及，非营利组织和营利组织之间的激烈竞争在美国医疗保健行业日益加剧。另一方面，联邦政府承诺削减对非营利组织的支持。在这种情况下，一些非营利组织，特别是大型非营利组织，正在由非营利向营利转变。同时，基层小型非营利组织虽然在这种情况下努力完成自己的使命，但也面临着严峻的形势。在这方面，他们的行动也反映了这种口是心非。

In this study, we report that many nonprofit organizations (NPOs) play an important role in the US health care system. They are major providers of health care services in USA,safety guards in community, and are advocates to solve the problems such as poors, wellness, some confricts existing in health care system, and so on. Furthermore there are a few economically large organizations and a lot of grass-roots small organizations in the US health care system as well as the US nonprofit sector. This sector has ecomonical duplicity and this also reflects the difference in functions which large and small organizations play in the US health care system. Specifically, the scale of organizations has an important effect on the role which professions play in the orgarlization. That is, in the large organizations, the professions are filling only the limited role in the division or promoting the specialization as a specialist. While, in the grass-root small ones, they are playing the main role not only in coordinating in the entire of activity but developing and meeting needs of the communities.Another result is that they can not accomplish their mission without govemment supports. Today, as a managed care is pervading around the nation, a keen competition between nonprofit and for-profit is increasing in the US health care industry. On the other hand, federal government undertakes to cut the support for NPOs. Under this condition some of the NPOs, especially the large NPOs, are converting from nonprofit to for-profit. Also, the grass-roots small NPOs are confronted with a critical situation though they are making efforts to acomplish their mission under this condition. Here, also, their action reflects that duplicity.