Competition in a publicly funded healthcare system

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1、ANALYSISCompetitioninapubliclyfundedhealthcaresystemAretheUKandothercountriesrighttoadoptamarketbasedmodelforimprovingtheirhealthservices?SteffieWoolhandlerandDavidHimmelsteinbelievethattheappropriateresponsetotheUSexperiencewithsuchpoliciesisquarantine,notreplicationWhywouldanyonechoosetoemulate

2、theUShealth-SteffieWoolhandlerassociatehospitals.Similarly,for-profitdialysisfirmsrushedincaresystem?CostspercapitaareabouttwicetheprofessorofmedicineafterthegovernmentmadeeveryonewithendstageOrganisationforEconomicCooperationandDevel-daviduHimmelsteinassociaterenaldiseaseeligibleforMedicarein197

3、2.professorofmedicine,Departmentopmentaverage.Fortysevenmillionpeoplearecom-Untilthe1970s,privateinsurers(mostlyfoundedofMedicine,CambridgeHospital,pletelyuninsured.ManyotherswithinsurancefaceHarvardMedicalSchool,andcontrolledbydoctorsandhospitals)andMedi-highoutofpocketcoststhathindercareandbank

4、ruptCambridge,MA,USAcareexertedminimaloversightofcareandpaymentmorethanamillionannually.1Mortalitystatisticslagcorrespondenceto:durates.Butsoaringcostsproddedemployersandgov-Himmelstein,1493cambridgebehindthoseofmostotherwealthycountries,andernmenttoassertmorecontrol.Intheprivatesector,Street,cam

5、bridge,MA02139,uSAevenfortheinsuredpopulation,clinicaloutcomesanddavid_himmelstein@hms.managedcareandhealthmaintenanceorganisationspatientsatisfactionaremediocre.23harvard.edu(HMOs)mostofwhichwerecontrolledbyinvestorsThisdismalrecordarises,wecontend,fromhealthAccepted:8November2007ratherthanheal

6、thprovidersandvigorouslyintervenedpoliciesthatemphasisemarketincentives.Evenastheinclinicalcarerapidlygainedafoothold.publicshareofhealthspendingintheUShasrisenInthemid-1980s,Medicarealsobeganencouragingto60%(box)investorownedfirmshaveeclipsedtheelderlypeopletoenrolinprivateHMOs.Governmentpublic

7、,professional,andcharitablebodiesthatprevi-paidtheprivateplansafixedmonthlypremiumforeachouslymanagedthefinancinganddeliveryofcare.Thepersonwhoswitchedfromtraditional(feeforservice)developmentandeffectofUSpoliciesthatm