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首页> 外文期刊>Journal of health politics, policy and law >Barriers to achieving a cost-effective workforce mix: lessons from anesthesiology.
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Barriers to achieving a cost-effective workforce mix: lessons from anesthesiology.

机译：实现高性价比劳动力组合的障碍：麻醉学的教训。

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As pressures to control health care costs increase, competition among physicians, advanced practice nurses, and other allied health providers has also intensified. Anesthesia care is one of the most highly contested terrains, where the growth in anesthesiologist supply has far outstripped total demand. This article explains why the supply has grown so fast despite evidence that nurse anesthetists provide equally good care at a fraction of the cost. Emphasis is given to payment incentives in the private sector and Medicare. Laudable attempts by the government to make Medicare payments more efficient and equitable by lowering the economic return to physicians specializing in anesthesia have created a hostile work environment. Nurse anesthetists are being dismissed from hospitals in favor of anesthesiologists who do not appear "on the payroll" but cost society more, nonetheless. Claims of antitrust violations by nurse anesthetists against anesthesiologists have not found much support in the courts for several reasons outlined in this essay. HMO penetration and other market forces have begun signaling new domestic physician graduates to eschew anesthesia, but, again, Medicare payment incentives encourage teaching hospitals to recruit international medical graduates to maintain graduate medical education payments. After suggesting desirable but likely ineffective reforms involving licensure laws and hospital organizational restructuring, the article discusses several alternative payment methods that would encourage hospitals and medical staffs to adopt a more cost-effective anesthesia workforce mix. Lessons for other nonphysician personnel conclude the article.
机译：随着控制医疗保健成本的压力增加，医生，高级执业护士和其他专职医疗人员之间的竞争也加剧了。麻醉护理是竞争最激烈的地区之一，麻醉医师供应的增长远远超过了总需求。这篇文章解释了为什么尽管有证据表明护士麻醉师以低廉的成本提供同样好的护理，但供应却如此迅速增长的原因。重点放在私营部门和Medicare的支付激励措施上。政府值得赞扬的尝试是通过降低专攻麻醉医生的经济回报来提高医疗保险支付的效率和公平性，这创造了敌对的工作环境。护士麻醉师被开除出医院，转而选择麻醉师，这些麻醉师不会出现在工资单上，但会给社会带来更多的损失。由于本文中概述的几个原因，护士麻醉师对麻醉师违反反托拉斯法的主张并未在法院获得足够的支持。 HMO的渗透和其他市场力量已经开始向新的国内医师毕业生发出避免麻醉的信号，但是，Medicare付款激励措施再次鼓励教学医院招募国际医学毕业生以维持研究生医学教育费用。在提出了涉及许可法和医院组织重组的理想但可能无效的改革之后，文章讨论了几种替代支付方法，这些方法将鼓励医院和医务人员采用更具成本效益的麻醉劳动力组合。其他非医师人员的经验总结这篇文章。

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