B MUPE HAYRH SCIENTIFIC AMERICAN Visganue Ha pycckom AsbiKeWWW. SCIAM-MAGAZIN Buumannio tumamenen! Vinmocrpuposanntit xxypuan B MIMPE HAYRH u3qaetca B CCCP c 1983 rona. Tipeacrasnaer coGoit w3aHne Ha pyCCKOM A3BIKe xKypHana SCIENTIFIC AMERICAN, BbIXOAAMero B CIA c 1845 rona >Kyphan ocnewaer Honenuie ROCTHOKENMA HayKiA 8 o6nacru ébynijamenransibix nocnenosaninin W mk npakT#WeoKix npunoneHa, ABTOpbI CraTeit, SeayuINe YueHIO PaakbIx CTPAH, 8 TOM sce M CCCP, ‘SHAKOMAT YMTATeNeR C NOCNEAHMMM PesyNbTaTaMM PaOoT No acTPOcusHKe WM RREPHOR cbusuKe, MONeKyNAPHOR Guonoruu M 300norMM, BsINMonATENGHOR TexKMK@ M NPOMBIUTEHNOM TexONOTAM, reonorwin w reocpiavKe, apxeonori, MeRMMHe, voTOpHN H NGHXONOrA. Kabid HoMep mypralia CORepmT BOCeMs PaaHOOGpAaHBix 10 TeMaTHKe: Nanwcaniex npocbeccnoHansHo m ysneKarenbHO, Crporo Hay4HbIa NORXOA K NPOONEMe COETAETCA C ROCTYNHOCTEH USNOMKEHHA Wnoagonser HeCne4NanlcTy NOSHEKOMUTKCA C HOBERUMMM runOTesaMI, MOAETAMM H OTKPBITHAMI. ONSYIC ROMO 8 3TOM OKAHIBGIOT 'MHOrONNCNeHHIe KDacoMnbIe HRNOCTAUAN. B oxypHane nMeIOTCR W NOCTORHHbIe PYODHKI: «kaHHe (Gcientific American, December 1986, Vol. 255, No. 6) 06 asropax 50. 100 net Hasaq Hayka 1 o6wecTBo Hayka Boxpyr Hac 3aHMMaTenbHbIn KOMNbIOTep Kyurn BuGnnorpacnaSCIENTIFIC AMERICAN Harry Myers PUBLISHER Jonathan Piel BOARD OF EDITORS Philip Morrison BOOK EDITOR Armand Schwab, Jr. Timothy Appenzeller John M.Benditt John Horgan, Jr David L.Cooke, Jr. ‘Ari W. Epstein Gregory R. Greenwell Robert Kunzig James T. Rogers Ricki L.Rusting Karen Wright ‘Samuel L. Howard Richard Sasso DIRECTOR OF PRODUCTION Gerard Piel (CHAIRMAN OF THE BOARD. Georg-Dieter von Holtzbrinck PRESIDENT {© 1986 by Scientific American, Ine. Tosapinatt suax Scientific American, ero Texct h uipuipronoe ogopsizentite ana MOTC NeXMOUHTE BHO COBCTBENHOCTEIO Scientific American, Inc. Mncnomsosani saect w cooTeerersin ‘e mueteaHomusin4 oroBopont B MHPE HAYRH THABHDIA PELAKTOP CN. Kannya JAMECTHTES FAABHOTO PEDAKTOPA 1.B.lenenesa HAYSHME PEAAKTOPEL 3.E.Komanopa O.K Kyapasos T.A.Pymakyesa A.M.CMoTpos ‘A10.Kpacuonesyes AM TEPATY PHBIE PEAKTOPHL M.M.Flonoga XYROKECTBEHHE C.A.Crynos, ANBEAY DUA PEAAKUNER T.0.Opak-KameneyKan PYKOBOAMTEML FPYTIMH GOTOHABOPA F.C.AsHMOB. TEXHHECKHA PEAAKTOP A. MypKnna. OS OPMAEHHE OBLORKH PYCCKOFOMIAANUA MT OKyKOB UPH@TOBME PAKOTHI BBE ‘APEC PEAAKUHU 129820, Mocxsa, CN hn PrixcKnn ney TEAESON PEnAKUNI 286.2588 © nepenoa wa pycexnit wasue wogopsuieuie, «Mup», 1987 Ha o6noxKe = Slt ANNAPATbI ANA NEPEABYUXKEHUA NO BOE Ha o6noxxe uz06paxex annapar nom wasnanuem “Flying Fish II" («Jleryuan ppi6a I>), npieoauneti B aaiDkeHMe MycKymeHOM cHMOM YenoseKa. Tloxasata craaua nomHoro HaGopa ckopocrH, Korna annapar nomepxuBacTea Onaromaps ABYM nos BOAHBIM KPAINbAM, a He NOMMaBKaM. ITO NpHMeP HOBLIX KOHCTPYKIUNH, KOTOPBIE 1B COPEBHOBAHMAX HA CKOPOCTS GpocaloT BEIZOB OOBIVHBIM TOHOMHDIM OnKAM (em. cratsio Anexa H. Bpyxca, Annana B. AGSotra, Jlefisuiaa Topaona Yuncona «AnnapaTe M8 nepensinxkeHus 10 Bore, HcnlOmsyloUle MYCKYMbHYIO CITY 4enOBE- xay ua c. 78). Pouumx wa annapare “Flying Fish [1” moxer npconoeT» Tpanitnt- ‘onnyto 2000-merponyto aucranumto na 10. ObicTPee, 4eM PeKopleMen Mpa Ha Om wouxe. Ero ckopocTs Ha KOpOTKHX aucraHusiax 2ocTHTaeT 13 ysnon, wis 6,5 M/c. Amnapar npHBoaHTcs B AaWKeHMe OMOGHO BenocHneAY: BenocHNeAHAA Lets MPO- XOAMT BHYTDH NOON CTOHKH K CBASBIBAET MeNIANH C BLICOKONHEKTHBNBIM TPeOHBIM, BHITTOM. PykoRTKH cOemHHe:tEI CO CTOHKOH NepemerO KPBINa, KOTOPAA CHYAHT TAK 2ke pynem. YcrpoficTBO B BULLE !ONATKH, KOTOPOE CKOITBIHT NO BoE Noses ITOH crofixu, ynpapnaer 3arny6nenvem KPbIMBEB. YUnnroctpayun OBNOMKA: Ted Lodigensky CTP. ABTOPIMCTOUHMK CTP. ABTOP/MCTOUHMK CTP. ABTOPIMCTOUHMK 7 National Medical 36.38 George Retseck 80-84 Hank Iken Enterprises, Inc. eee 45,48 George V.Kelin 69 John Moss, ¢ 9 New York Sh Beata ‘Archaeological Rexenyof Kramarsky ‘Superintendency icine 4851 George V. Kelvin of Ostia 1043 Jerome Kuhl r f 52 Fernando De 9094 Tom Prentiss 17 Bill Sanderson, Noronha : ieee 95 Tom Prentiss PCrutchfield 58 George V. Kelvin (coepxy); Sohn 18, 19 Andrew Christie ard i 2 nea, td feces = ae 60 Julie H.Sandell Superintendency lew Christie of Ostia enusy) 1 Iselin (eaepx)), James 61,82 Alan D. sel 97-401 Michael Goodman P. Crutchfield 63 Richard . (onu23) H.Masland (@ 99, 101 © Minotaur signs 22,23 James a CROUCH 105 David Di P. Crutchfield oreo Francesco, Pixar 24 Harry L.Swinney, 65,66 Alan D. Iselin 106 Lucasfilm Lid, ‘Anke Brandstater, °° > anon (eaepxy); Johnny University of ee F. Dacheux, Elio Johnson (e1u2y) ae su Raviola 107 David Di James Francesco, Pixar P. Crutchfield a8 Raney Moe (eaepxy), ay baiaar 72 Patricia J. Wynne MacDenald- Observatory 73 Randy Moore ou 22,93 George Retseck 7476 Patricia J.Wynne 49g David Di 95 Michael J. Kurtz 79 Martyn Cowley Francesco, PixarOT PEAAKUMN YPHAN 4B MHPE HAYKH» perysinpxo BBIxo- ant B ceet yoke natsiit ron. H Bat aepxwre 'B pyxax 50-Mt ero Homep. 3a 970 Bpema crano CHO, HACKOMIBKO TAKOE HS/1AHKe AKTYAMBHO H B KAKOR CcTeneHH eTo TORBsIeHHe OTBeMAeT Salaam conpemen- Horo pasBiTHA HayKil. EcmH 4eTbIpe roma HASAN >yP- Hast BBIXOAMA Ha aHTaMAcKOM, (paHuy3cKoM, HcnaH- CKOM, HTANBAHCKOM, HeMetIKOM, AIIOHCKOM, KHTall- (KOM H PYCCKOM ABEIKAX, TO CeromHA XK HUM pHOABK- lich BeHTepcKoe M apaGcKoe HInaHKA. Yeenwsustcs 1 ero scenupHEtf THPAX, MPesbiuraIoNU omMH MUA (OH 9K3eMIIARPOB, HECMOTPA Ha Bo3pOCIlIYIO 3a nocmTeN- Hie FOMD KOHKYDeHIHIO CO CTOPOH! HORBIX HayHBIX 1 HaysHo-nlonynapHeix xXypHanos. Tpomsomm TaKKe namenenna B Caienmudux Amepuxn, Hux. Iokepapn Thnx, KoTopstit ta mporsxeHnH NOXTH copoKa eT HUT aaaTenem KypHasia, Cras MpencenaTesIeM COBETA Mit- pexropos xomraiti, I. Maliepc — wantarentem Caiien- mugux Amepurn, Ipxouaran Tun — penakropom, a pesunentom Kommiasi — Teopr-Jlurep box Xombu- Spun, rmana sananMorepmantexofl wanaTemcKolt KOp- nopauim «ox Xombupunx rpynn». Tpwsiasstem Gonbumx sacayr D>xepapaa lia 8 o6actH nonyaa- DSauuIH HayKH HM pasBHITHR MeXAYHAPORKOTO COTpYA- Hutmectsa aBILIOcE npucyauteume emy B 1985 r. crenieust NoweTHoro AoKTOpaHayk MockoBcKoroTocyapcrser- Horo yHunepcuteta uM. M. B. JlomoHocona. Buesiom crit, comepskanie « HanpaseHHOCTs H3- {aHMA 3a NlOCmeAHee BPENA HSMEHHNHcH HeaHasHTesT- Ho, But MoxeT, OCHOBHBIE CTATEH CTAM HECKOMTBKO, KommlaxrHee. B HX 10-TIpeXxHEMY COsIEPKHTER TORHOE W aBTOpHTeTHOe H3OKcHNE BAXXHeMUNX COOBITHH B MMpoBOfl Hayke. YBesIMSUTOCE HHCHIO CTaTEH COBETCKHX aBtopos, nyGnuKyeMBIx Kak B >KypHae «B MaDe Hay- xi», Tax Catienmuux AMepUuKH, XOTR3/1ECb MOKHO 6s1210 Gus Ox HATE GombUe! AKTHBHOCTH HALLHX aBTO- OB, KOTOPIM 3akasKInalOTcA CTaTbH. 3HaKOMCTBY aMepiixazicKoft pelaxuin w nepeBoaHtstx PenaKintt 9TO- O2Kyptiata B APYTHXcTpaHtaXxc cOBETCKOH HayKOH H TO passnTofl cHcTeMoMl Hay4HO-TONYARDHBIX KYPHAMOB, xoTopas ecb 8 CoseTcxoM Co103e, NocayAxi10 MPOBe- eine » Mocse 8 1984 roay MexayHapoaHol BcTpeHH eNLAKUIMOHELIX paGOTHHKOD Bcex HaNaHNi KypHATA. Tlossimienne murepeca K >xypHany BO RCeM MHpe oBtachaeTer ettie x Tem, 470 Gnaronaps GombuIoH pa- Gore peaaxropos, mepesoauukos omurpaductos 2kyHAN B NlepesonAEIX BapHaHTaX BLIXOAHT OMIHOBDE- Metito n pasibix crpantax cnycTa minis sina Mecatta O- cmte patxona Catlenmugfux Amepurn B CWA. ITO saeT BOIMOKHOCTS MupOROM HayeHoft OuLecTReRHOCTHE SHaKOMHTBEAB O”HO H TO 2Ke BPEMA C OMlepATHBHOH HE opmaumel mo axTyaNbHSIM BOTpOCAM HaykKH ‘TeXHMKH. B xypnate no-npextemy samerHoe Mecro sanuMa- or cTaTBH, NlocaAULeHHBIe MPOGTeMAM MDa H pas opyxenns. Hanvicautiste BuIEINE YHeHEIM, 3TH TyOAHKaNNM HeCOMHEHHO crocoGcTByIOT BEIpAGOTKE MayaHAIX mpentcranneHAit no TaKHM MpoBNemaM, KaK TmoGaTbHBIe MocTeNcTBHA sTepHO! BOMHEL, KPHTHKA ‘COM, SHawuTenbHBIA HiTepec MpeucTaBnsiOT TeMaTH- MeckHe BLINYCKH XYDHALNA, NOCBALLEMEBIE OTAEMBHBIM. ayHbIM H TextiHecKHM mpoGnemam: «Zlurianuesnar Seman» (1983 r.), «TTporpaMmrtoe oGecrrevente 3BM> (1984r.), «Monexyzs1 austin» (1985 r.), «Honbte mare hans» (1986 .). 97H BbInycKH nevaTamich yBemITIeH- HIM THPAKOM H TlombayIOTeR GONBUINIM CMPOCOM Y Ka- ‘aunx sarrarened. Tloanons Hexoropsie Hroru 3a npomiesmse roast, ‘cueayet aynars 10 GynyuieM. Ceroaia pecs KoMIteKe ‘BOMPOCOB O BIIMAHMM HayKH Mt TEXHHKH Ha COMAMBHOE 4 9KOHOMHNecKOE DazBHTHe OGulecTBa 3aHUMACT HC KmowuTesbHo BaxkHoe MecTo. B TOM, KAK ITO MPOHCXO- AMT, KaK Hay¥HBIe HEH CTAHOBATCH YaCTBIO OBULEcT- ‘BeHHOTO COsHARHR, KaX OHM XTHBHO BXORAT B COBE- MeHRY1O KYMBTYPY, CYULECTREHHAA POMS MPHHALTEKHT TOnyApHSAILAH sHaHHIl, Bonet Toro, BBIXONA 3a WHICTO mpocseTuremsckne yHxusu, sasiava pacnpocrpane- Mi Hay4HOH HbopmauMN Bee GombuNe NpHOGpETaET ayao-counaTtbHoe swavenne. Tlostomy ceromus taneptioe npaniasstee ronopstT® He CTOMDKO 0 MlOnysApHBaitAH HayKIt, CKOMBKO 0 €€ NPO- naranine, yuuTLIBaA TeLIMpOKHeyHKUUH, KOTOPHIEHA- yka npnobpetaet 8 cospemention: mupe. JTOMy OTBC- aeTH TO, YTOBTOCTEMHHe TOMB! 3aMeTHO BOSPOCTa aK- ‘THBHOCTk MUPOBOTO COOGMLECTBA YNeHBIX B GopLGe 38 Mp, npoTus siepHOft yrposbt weslopexecrBy, Bospocita ‘OTBETCTBCHHOCTE YAeHIX 3a TO, KAK H Ha 4TO BANAET Hay- Xa B COBPeMEHHOM Murpe. MoxKHO ZYMATE, 470 BCE ITO afineT cBoe BuIpaxenite B penaKIMOHHOM NOMITHKE HB conepakanmin Hamero xxypriana B O6o3priMoM GyzyiteM. mpooeccor C. M. Kanuua ABHBIM PEDAKTOP 2KYPHATIAO6 abmopa Donald W. Light (IOHAJIbA JIAMT «Bommmmste xopnopaum 9 anpapooxpanien CUA») — nposec- cop » oG actu oxpatist 3A0poRbs 1 it~ xwarpitt 2 Uxone opronenw ups Yin- pepctTere oGuleR Menuet Ht cTOMa- ronorm » Huio-Jbxepen, a Tacxe npogeccop couonorum Yanpepcu- ‘Tere Patrepca; OW K TOMY 2e sBnAeTCH oamun 3 pyxosomurenett Hucrutyra 2xOHONKH Satpasooxpanieuun JleoHap- aa etisuca npu Ulxone Yoprona. B 1963 r. Jlaitt noayann crenenb Gaxa- snagpa 8 CranopricxoM yuitwepcurere, 8 1966 r. — crenen marneTpa 8 “uKar- exom yunpepourere u 9 1970 r. — ere- ent noxropa 8 Yeupepenrere Bpai- aneiica. Hecaestonanie, pesysibTarst KO- Toporo ner: B OcHODY ero crarsit, Bt- 10 nposesteHo JTafiroM no saxasy @ou- sna XX pexa. James P. Crutchfield, J. Doyne Farmer, Norman H. Packard, Robert S. Shaw (DKEMMC M1. KPATY@HIIL, IK. HOMH @APMEP, HOPMAH X. TIAKKAPL, POBEPT C. OY «Xa- oc»), Gynysnt eure cTyneTaNH-xKaT 3a- nomHenueie Bonofl nonocrH 4 expanutes- ble PacTirrenbubie H KHBOTHBIC OCTaT- xm, Onnaxo Te, KTO HenocpencTBeHHO paGoraior c amaazamn # pacnonaraiot Goniee KoRIKPeTHEIMH CBeTeHHAMH O HULK, currraior, 470 ckopee BceTO OHH HMeKOT ByaKaMnvecKoe nponcxoxmenne. Ham xaxerea, aro «Manufacturer's Gazette» npasa, cooGuian 0 TOM, "ro Pacuimpmiouicecs sicriombs0BaHMe cO- AepxaLx omit H MOMOGKBIX ey pe- naparoR /18 CHNTHR HepRHOTO ROBY K- ews seit, HaoGopor, A:ma cTMMAy:IIpO- ‘Baws OpraxitaMa npencrasaNeT 111% Ha- ‘nett crpanat 310, KoTOpoe MoxeT GhiTs 5 nak Bombine, YeM 3110, KOTOPOE MPHHO- cuT ynorpe6neawe anxoromiix Ha- urKos. B Macconofi npecce 06 3ToM ro- BOpHTCR Maxio; H NpOTHB ux yrlorpeGne- Hua He cywlecTByeT mHPOKOTO ABIOKe- Ma, KaK npoTHs noynorpeGaeHms an- xoronem. Kopapxbiil xapaktep mpHBsi- Kaila K sleKapeTpaM slenaet Hx Gonce onacusinm. OrposHoe GonbisnucTso ‘Tex, KTO HawnHaeT a7bIOBATECR OTH em, MopdileM su xnOpatem, nenaior 370 No MpesmMcaHio Bpava H WacTO HE HMCIOT BOIMOXHOCTH Y3HATB, TO OHH ‘npwHuMator, noxa mpupuiuKa K sleKaper- BAM He OBMlaeeT HMH NoMHOCTHIO. Ta- koe GecneuHoe OTHOMIeHHe K 3nopOBKIO 4 okYGHH HeTOBeKA CO CTOPOHD Bpavelt AODKHO PaCCMATPHBATECR KAK YTONOB- oe mpecrynsienue. Xora npowsmonerso mmuyuuex sa- IHOK KaK OTPACMTs MPOMBIULAEHHOCTH ocTHrNO B HacTomuIee BpeMa GonBIX MacurTa6os H KpynHisie MPOMBIMTeHE- ‘KH OKaSBIBaIOT EMY MOCTORHHOE BHIMa- ile, MOoKHO CkA3ATB, TO OHO HAXORHT- (8 THUS B HawATHOR CTAMH PasBTHA. Tlonssa oF nuiyuux MaMIMHOK cTom ‘BemIIKa, HX YorIeX TaK 3aMeTeH, a HX IPH MeHeHHA CTOMS MHOTOMHCRCHHS, TO erko MpeniBHETS, KaK B CKOPOM BpeMe- it OME PacnpoeTParinTeA TIO BceMy UH BUAUZOBaHHOMY Mupy, NlOROGHO acam UIBeMHBIN MaLIHKAN. TipoGnema coananis oKoMoTHEa ‘is NepeneuxeHts To cyure wiTepecyeT MuorHx wraTenefl Hawero >xypRana. Ton Jlanewana, Tarantnnesit pan- LYSCKHM MexaHUK, TONBKO WTO 3aKOHUA nocrpofixy naposolt TpexxonecHotl Ma- ‘IMEI, 8 KOTOPOMI B KaNecTBE TopIO¥erO ueriomsyeres nedrs. T-# Jlannemana ye copepunin a cooeM MaMHHe WeTEI- Pe noesaxu. Ha posxoft nopore aasne- nite 2 aTM MOIRONSeT TAKOMY OKOMO- ‘ritny PasBuBars cKopocs oT 3,5 0 4,5 MIU B Nac. Tlapoaax mpexxonecnax mauuna, paGome- vowas wa wesbosIbHVYHbIe KOpnopaluu B 30paBooxpaHeHun CILIA Tlosenenue cere KOMMepYeCKHX OONbHUY ABUNOCb pesynbTaTOM MHOroNeTHero TpagnynoHHoro Nogxoga kK oxpake 3fopoBbsA B CLUA ¢ Nosnywy u3sBneveHuA Bbirogbl. MlpoyseTanve Nogo6Hbix yypeKAeHnn ceugerenbcreyeT o Npucyujem aMepuiKaHcKo cucTeme 34paBooxpaHeHusA HepaBHonpaBun ‘OBASI 3PA 8 sapasooxpareniat Hats sce oreer neve 1968 r., xorma T.Opner Tbe. Maccelt (nepsifi — spay us Hau buna, BTOpOl — YenOBeK, cosmaBunt HauHOWAMiyIO cer —_3axycorDsx ‘ellsinnesiox no-xenTyxxexH») oprani- gona AMepuxanicryio Gonsnusnyto xopriopauinio (ABK), ciia6amp wacTuyio Gomuainuy dpucta, pacnoroxennyio B Tlapx-Buto, xanirranoM, neoGxomnmuist saa nanbuefiuero pacumpennn. Berope ABK avana npuoGperars pyrite Consist, H 8 HacTommiee BpeMs 3TO Ye cama umpoxan ceTk GonbHit, npnmannexaumx sxnansukam. B Mo- MettT o6pazonatiia yrowaryrom Kopno- DAN HUN HeMHOTKE WederepambinEIe Gonbimus HeoTAOKHOH NoMoUN BXO- ‘AMM B CTs MeAMUHHCKHX yuperKaeHM, npmwocauux oxonst. K 1983 r. cern Koninepueckiix CTauHOHApOB KOHTPONI- onan yxxe 13% non0Gxe1x Gonsamu. Tpanchopsauns, abrspannas coana- nest cetelt ontsepsecki Gompatni, Cepresiiee, Heo MORHO CYAHT® Ha OcHO- ann mpouenTusrx noxasarenetl. Cuna "npusepa i nagnexe npaMoli KOKYPeH- luna cerelt KoxaMepseckix Gombun 32- Craw HexoMMepyeckiie cTaUHOHapAt oGseanuxTsex B coBcrpewse cern. B acTomuuce Bpema oxono Ys GombuM Nott noMouM oGvemueNbt a Kopnopauim, npnasiexa- Me axsammKaM, «saxsarus nos 1» BO MHOLUX spyrux OGaacrax oxpanss sa0poB6s, Haumian oT nyHKTOB Tepsianofl MemiKo-canstrapHioft nOMO- ut 1 KoHvaa cneuHamHsMpoBamMBINH seveOHO-KONCYABTaTHBHIBIM UeHTpA- Mu. CneayeT OTMeTHTb, O7HAKO, TO OMMepMecKHe ceTH BaIOTeR ToMl op- ‘Moll KopnopaTusHoro npusiuina oGcay- >xiIBAHHN, KOTOPAK BHIIKIBAET OcOBEHIO Gypmte antcxyceams. Korna xommepwecxstit yx, npHeyini AOHANbG Y. NANT saxycousin, mpouuKaeT B cepy Gon HuMHOTO OGcHyxuBAHNS, TO Cpasy CT BATCH TOA COMHEHHe ‘TpamMMOHHEIe Npeacrapnenua o Memuuiie Kax 06 omit eTBopeMiiH ryManHOTO Hawalta H MnO cepaua. Cet Gomsauu, npinantexa- ule BknaduuKaM, Tai npexMetom KPHTUKH Co CTOpOMbI npeacTasuTestelt akasleMuMecKofl MeNHLNHL, TaKHX, KaK A. Penwaua, npoeccopa Kadenpst Te- panun Papsapacxofl MeaMumicKofl uiKo- Jet Mm penaxropa -xypHana «New England Journal of Medicine». Ou x Apyrie cleuslanucres cuHTaloT, 470 cO- OGpaxeits BRIFOAR «nompeIBAIOT) uyBeTHo OTReTCTRENHOCTH BPaya nepest cBoumu GombHBIMH, MoryT npuBecTH K HenykHBIM MpoBepKaM MH MmpouenypaNt Mam (apm mpyrHX dunaHcopIx cTHMy- wax) K HeaexsaTHoMy aeyenio. Kpi- “TuKHL TaKiX KOMMEPYECKHX CeTeMl TAICKE BHICKASbIBAIOT NONOSPEHHA, TO OHH 3a- BBIMIAIOT HeHbI Ha MesUMUMHCKOe OGcAy- AxUBAHHE, CHIDKAIOT €FO KAYECTRO, HE YaenMOT AOIHOTO BHMMAHHA NO;rO- ‘Topke kaapop it HiccnenoBaTenbcKolt pa- Gore 4 oTKasuinaioT B nOMOUM TeM, KTO He Moker maratrs 3a eyenne, Ho ‘Mepe Toro Kak eslepanbiioe npapitrenb- TRO M HacTHEIe CTpaxonbie KOMNAHIN NpeaNpHHHMaIOT NOMBITKH COKpATHT 3aTpaTbl Ha Oxpally 320poBbA, Orpartit- 4npas Aoxomt GomHm H cTaBA HX ne- Pe HeOGXOAHMOCTHIO CHHZHTE co6- CTRCHHBIe PaCXONB, MHOTHE 42 3THX cooGpaxenuh npwo6peratot ocobyi0 ocrpory. Wcenenosanns, wanpannenmbie Ha XpMTUMecKyIo OUeHKY AemTenbHOCTH KOMMep¥eckHX Gonbitu, npHOOpeTaIoT KOMMNIEXCHBill xapaKTep; OHO H3 TAKHX ccalenopanuit nponereno Hestasno Mu- cTuTyTom Mesut Haunonans- Hofl akaemuu nayx. FlonyvenHbic aan- ble, PACCMOTPEHHBIe B KOHTeKcTe CTPYKTYPEI_H 9KOHOMMKH 3paBooxpa- 6 HeHHA, KoTOpBIe erm B OCHORY opra- HM3aLKN ynOMaHYTSIx ceTell, 1aK0T BO3- MORHOCTS OUEHHT Pon’ nocsteAHNX. HexoTopiie ns maiasnnyritx oGautteMah He cOOTBeTeTBYIOT MefiCTENTeNbHOCTH, Torna kak apyre snomHe OGocuoRaH- et. OnHako HenOcTaTKH KOMMepNECKEX Gombuny wenb3a paccMaTpunars Kak ‘cnoficrnenibie Tomko uM, ‘STH Gomi MBI ECTS He 4TO MHOe, KAK omLeTBOPE- Nile B HHCTOM Bulle Ayxa MepKaHTHAMS- ‘Ma, KOTOPBIFI MpoNHsbiBaeT BcIO aMepH xavckylo Meanunmy. Onn Gessacrewsi- Bo cneayIoT NpHRUMNY MpescTARNEHHS OntuMambHoro MemuuMHcKOrO oGeay- 2xupamia 32 moGy10 ueHy Gossiuel ¥a- TH oGwecrBa H hakTHyecKH OCTaioTes [yXMMHK HY:KMaM OCTABHBIX ero Wae- Hop. B 9TOM CBoeM Ka¥ecTBe KOMMEpSe- cxue GombMubt cayKaT NyBCTBHTER)- HBIM sIMarHOCTHYECKHM CpemIcTBOM Bi spieHua BCeX HecnpaseniMBocTel xpafinoctefi cyulecrBytoulell cucTeMit aMepHikalickoro 3npaBooxpaneniin. ‘OBBIMH ans amepukanicKonl Menn- MHL sBAIMOTEH TONBKO MacuITa~ Goi MepKaHTHAU3Ma, NpOHUSBiBALOUETO AEATENBHOCTE TAKUX GOmBHNUHEIX ce ‘Tell. Hecmorps va To 4ro GombunieTBO Gombinu TpAMHUHOHHO GEiTH «106pO- BOMBHBIMHD, T. e. HeKOMMepMecKHM, JHPERIEHWAMH, HAXOAAUINMHCA B Bee HMM MeCTHEIX OGuLeCTBEHMBIX accounta- uu UL penurwoaHeix opranianiit, Bee %ke GuITO M sHANHTENBHOE HCO Gonsunu, KoTopsiMM pykoBomHN wacT~ ple siapenbust, OGKYNO Bpaun, WET KOTOpHIX JaKMOWAAch B MBIEYEHHN Aoxon0B. B 1928 r. 38,9% oF oGuero uucna 4367 nerocyaapereenunix Gonb- Mu OGulero THNa HaXOMWANCe B Hact- HOM BaaneHuH, 1 370 Gombitie, Hem ce~ ToaHA, HecMOTps Ha poc aca KOM- epyeckinx Gomi ‘Sm nepsute wacTHbe Gonbumst Gb1-{nM concen HeGonbuIHMat, H Ha MUX pH XONMAOC TomAKO 11.1% BCeTO KOeMHO- ro donna. Bpayx wacro orkpbisanit Ta- ule CTauoHapMt noTOMy, #To noGmHTI0: CTH He Guto noGponomLix Gombe, aH NoTOMY, TO OHM He MoraH nony- MuTTE NpHBHerHH Wa FocmHTaaHsaUIO 01x GonbiAX B Gosiee KpynHBLe H pe- cruxnsie yupexmenus. Kavects0 06: CoYARMBAHUK B TaKHX YaCTHBIX GombHH- UUaX 65110, KaK NpaBHnO, OH HHSKUM: B HeKOTOpHIX PerHoHax GonbHbIe HAIBI- ‘ami 9TH Gonbititet «KPoBOcOcaMsH. K 1934 r. exeronnoe o6cnenosanue Gonuunu, ocymiectansemoe —Amepu- KacKofl MeaMuiNcKOM accounauuetl, BKMIOWATO HOByIO KaTeropio — «Kop- Nopanni, HeNHMNTHpOBAHMEIe B OTHO- ueHHH MpHBLAM», "TO ABILTOCE MPH stamens Knacca GonbiML, npuHamexa- luuex eprkarensm axuntl, a He OTERL- MbIM BagenbuaM WAM naprHepam. B YKA3AHHOM TOMY B 9TY KaTEFOPHIO BXO- uno 32,4% wacrmax Gonsim ¢ Koc MbIM GonAOM, cocrasnasuM 52.3% OEX KOCK 4ACTHBIX GONBHHLI, TAK KAK Kopnopatuninie craumoHapst mpensi- luianK No pasMepaM apyrie wacTHBIC knmnku. B Tewenwe cnenyiouuex Tpex DECRTUNETHA HeKOTOPHIE 13 NepBEIX KopnopaTHpHsix HM ApyrWx YaCTHBIX Gomsunn oSankporunncs, apyrne 6biaH Npespawensi B myMMuanbDte Gomb- HMUBL, a OcTambibie nponOMKAAH Oy:RK- UMOHMpoBATE, Ho yxKe He Kak Kpyni cneumasuisuposaMinte sTexeGHmie saBe~ Kopait cospemennioro Mepxanrinms- Ma yxonwr rily60Ko 8 OcHOBY TaBHOf ‘TpaAMUMH aMepuKaNcKO! Mesut. B nepwoa Mexxay 1870 1910 rr. aocTwxe- uu 8 oOnacTH Gombwol xupyprant a Gops6bi c mmtbextmonHbIMn GosesHAN npuinean KCTPOWTeNbeTAY THICHY HOBLIX Conpunu. Tpexnie Gombnsust wacro cyAGUIN MpUCTANMIIEM aA HYAAAIO- luurxca m ysmparouiux. Hoste Gone ust MpHEneKaTH naTexKecnocoGHEIH KoWTHHFeHT GombHBIX H BHEAPATH pH ‘unin AenoBoro npennpimuumarenueTBa *MEQMUVHCKVA TOPOAOK» 8 fer per-buy, wrar Onopyga, NpuKaANeKHT KOMMepYecKOR GonHMHO! KOpnopa- an National Medical Enterprises, Inc. Kownnexc o6teawHner GonbHMuy O6\e- Fo Taha ¢ NcwxMaTpAYeCKOA chymGOR, HTP Ana NeveHMA GonsHbtx, CTpagawe Wx HapKOManWeR M @NKOrONMSMOM, loppasqenewia Ana peabunnrayun PeKOHBANeCYeHUWAM; FOPOROK pacro: NOKeH Ha TeppMTOPHM NnowaRDO 16,6 kw®. Tlocne nepuona ycnewkon per: TenbHOCTH B KaYeCTBe ceTeM COnbHMLy ‘o6uero THna MHOFHe KoMMepYECKHE CH Teme! NPOBOART B HacTORWIee BPEMA agepriKanbHyio UHTerpayinio® W NpeRO- cTapnmicT pasHooGpasHoe MeAMUMH- koe oScnyxuBaHne.8 B MUPE HAYKM\. 1987/N° 2 B CBOIO NosceRHesHy!0 sAeTeABHOCTE Alaxe Consuuust ats GeaHBIX, KoTOPHIE ‘TPAAHUWONHO He BIHMATH aT 3a ne- MeHME 1 3aBHICEIIH B OCHOBHOM OT utesI- PocTH dinanTponos, cTpeMumIce roC- nuramwaupopare —naarexkecnocoOHbix Gonbasix, Tax Kax aenpeccna 90-x ron0B mpoummoro croneTua oBycroBiLIa co- Kpaulennle nowepraosanuit, a BbIcoKan udaaust — ysenusenite pacxonos. 21. Pochep, wanectusiit cneunanner no HeTopuH Meu ws KonnenxKa Bapyxa np Hyt0-Hopxcxom ropon- KOM YHRepeHTeTe, yeTaHOBHIA, 4TO nonewsrenu Goneinu nna Geaneix cTpe- MHUNICR BeRMECKH SanonyNHT® Bpavell, MMeIOWHX YaCTHYIO MpaKTUKY, B_TO- MBITKe MpHBAeMb wx GoraTHIX MaueN- ros. B npextue rons nox0GHsiit KoH- ‘THHFeHT npennoMNTan sewTECA B 20- Mammnx yenonusx. B To 2Ke BpeMs al- MumicTpaunix Gonbunn saa Gentex ‘Npupena B OpAAOK Nasiarbi Ht BCAYECKI Peknammposana —_mpeslocrannsenth yao6crsa: MeMBIe KpoBaTM, KaMMNDI, Gnaroycrpoenmmte neveGubie noMeule- Hua, MIUUARIAYAABHBIe CecTpHACKHE T1O- TBI H xopoUyto Kyxm0. B 1899 r. B ra- gere «New York Times» npuposiuioce cnenylouiee BbICKassIBaNtte OsHOM MO- onOR renuunet: «xHBa- wa Hei0-Mopka (oGuiccTBeHMbif ro- PosicKoA KoNFaoMepat) Gosbiiubt donna Kaftsepa (wexommepyeckas OT13, BIaNICIOULAR WINPOKOA cucTeMOM Gos mu, 8 ocHopHom 8 Kanuopruu). He- KOMMCpMecKHe CHCTEMbl BO MHOFHX OT- HOUIEHILEX TOXOAKM Ha KOMMEpHECKHE opnopaui. Oum yapexsiaior Want npHt- oGperaior OFM, OT13, peaGumrrann- OMMBIe MENTPHt AMM AML, CTpANAIOUINX AAKOTOMHMOM H HaPKOMAMHER, HT. J. Ynpassnior apyrumu Gonbeunasn, BKIAABIBAIOT KAMHTAM B HEMBIDKHMOCT 1 AeHaIOT 3AKYMKH Ha sLNCKONTHOR oc Hose. Tonyvaior npuGbitb. B 1983— BTEYEHME 1969. 1970-74 1975-79 100 150 weno BOnbHHL, TnI BONLHIL, CETH, RPHHARNEKAWME RAnUKAM [Ei mcr snort CBETCKNE HEKOMMEPYECKHE PENMTOSHBIE HEKOMMEPHECKHE TATA Mit MECTHEIX OPTAHOB YNPABIEHMA VICTOUHMKM NONONHEHHA corer, ApHEANeKAuKX —naAWAKAM, UOMeHR ‘uce CO BpeMeHeM. J[Marpamma noctpO- HaHa ocHoBe CTATHCTHUeCKHX AaHHBIX no WecTH KpyNHBIM KOMMEpYECKHM 1984 rr., Hanpumep, noxome! neKoMMep- NecKHX ceteft Gombunu (Ges yueTa uep- KopHeix) yeeanunnannce Gosee Guict- PLIMH TeMnaMit, eM Oxon ceTeM, pwianeskauux nafiuunan. Tipruinanbuaa pasunua octaetca, oanaKo, weusMennoli. BMecTo spina ‘Tbr AMBHeHAOB aepxKaTERAM AKU He- KOMMepMECKHe CHCTeMbI BKJanBIBaIOT BOM MOXOAL ~B HOBIE HN yconep- ueHcTBOBAHHBIE cpencTBa OGcIyxHBA- HUA, B cosmaliHe PesepBOB Ha KaNWTa- AOBAOKEHHA HK ALIX OKAIAHKR OMO- unt meunyuuin. Muorue penuirnossie Ceri HaCUHTBIBAIOT onMH-2Ba yORITON- LHLIX BAYTPHFOPOACKNX CTaUMOHapa, KO- ‘Topsite nony¥aloT niommepKKy OT Gowtee mpeycnesaroux Gonsunu. Kpome To- ro, Gomburag wacTe HeKOMMePYECKHX ce- ‘Tell He NPORBARET CTPEMAICHH K GecKO- Gonbuwuneim cetam: Hospital Cor- oration of America ( AwepuKancran Sonbwunan Kopnopaynay, Humana, Inc.; American Medical Enterprises, Inc. National Medical Enterprises, Inc.; Chart- ‘er Medical Corporation Republic Health Corporation. Ha nepasix nopax CeTM pacwiMpAnncs nouTM ucKMOUN- ‘TenbHO 3a c¥eT NPMOOPETeHHA MB eA ux cnywanx 3a cueT apeHqonannn (yeernan Yacrs) rnasHeim OGpasom He SaBVCHMEIx YaCTHBIX GonbHiu. MosaHes ‘OHM TaiOKe NOKynanu OONLHMUb! y APY: Tux cere, NlOMMMO NPMOGpETEHUA BO ce GonbiueM KonHuecTBe HeKoMMepNe- ‘cKuX M rocygapcTseHHiix GonbHnly. Kopnopaymn yeennuneance Hi 3a cueT CrpowTenscrBa HOBbIX CTAyMOHapOB (cepsii yser). Haunan c 1984 r. 8 caRSH © yrpoxaiouwm poctoM MsGbITKa KOeH- Horo choga pacumpenue KopnopaywA Samegnnnoce. pw noctpoeHum gHa- TpaMMei McnonbsoBanuce AaHHBIe, CO- Opaniie 9. Hon 1B. [pee — cotpya- Hukamm MequuaHcKoro uHCTHTYTa. Heanomy pocty. B Gomumnerse caysa- ep ON cyuecTByIOT B nepsy!o ovepeab ana o6cay>xusanns cBoux Gonbinu, a He {LAA CoIMAHHA KOMNUeKCHO! CHCTeMBI 8 Pacuete Ha oGciyaHBaNHe HaceseHiR ‘cell crpanet nH Gombworo pernoua. B peaymbTate —pocT — HeKOMMepueckHX Gosmpununsix cerell suawuTesibHO COKpa- ‘Tunica. Tem BpeMeHeM KPYNHbIe KOPHO- Pau, npHmateKauime namiuunKam, He- (MOTPA Ha TO, ¥TO WuCO HX GomBHML He {YBEAMMHBACTCR C TAKOH CKOPOCTBIO, KAK TO Gbil10 panbatie, npomomxKalOT 3axBa- ‘ThiwaT apyrve oGactH sapavooxpa- Henna. B uiiom oTHomennm pasnuna Mexty asyms Tunamu Gomi crHpaercn. Kopnopatusneifi xapaxtep aextenb4o- TH, nopoxknenHsilt neweSuEIMM yupene- AcHHMH, MpHHaZIEKAMNMN nafiuinte12 Kam, PaCMPOCTPAHIVICA Ha BCIO cHICTeMY anpasooxpanenus. B npouinom aman MMCTpaTHBHOe PyKoBO”CTEO GombHMtL He HMe0 NONATHR| OG HCTHHMBIX pasMe- ax pacxowlos Ha comepxkane onepaut- OHHOrO OTAENEHHA HIK OTMENEHHA HH= ‘TeHcHBHOR Tepamun. B wacronutee Bpe- Mal KOMMepueckHe CeTH MoNaIOT Mpuntep Beem GonsHHUAM, BBORR 8 MpAKTHKY CHOxMBIE MeTOABI YupaBeNHA MH Sopmannonuse cricrembs asts yuera no- crawox, nepconaia, Gonbibix, pacxo- ‘0B H HOxos108, OHH 834K Ha BOOpY>xe- Nile MeTOWLHI MHVTEHCHBHOTO MapKeTHHTa 1a npuaneveunn oGecnevenmbix Gonb- BN: BEM OMAHOCT KOMMepHECKOTO aupextopa, npeayemotpent KONTHH- Tent Gombubix, uMetoulsix npawo Ha wie ApyIo KoMneHcautto no sulHnH counan- HOFO CTpaxoBalins, TAKHX, KAK NCHXHNE ‘xn Gombasie H paGoune, pacrionaraio- WWW. SCIAM-MAGAZINE NAROD.F B MMPE HAYKM- 1987/NP 2 pHMepy, NOCTORHHO pacreT. ‘OGecnevenne yno6eTs, TAKHX, KaK pa- MMOHAIALN BINNCHIBAMNR CHeTOR K onsate M nasHaNenne yAoGULIX Yacos Rpvema, Takxe BxOANT B CTpaTerMio MapKeTunra, OcyUlecTBAAEMyIO KOM- Mep¥eckHMH KOpnopatuiaMit 8 nionbrT- ax co3aTb BiieHaT ene 0 cB0HX Gob nuax kak 06 adexTusubix H pecnexTa- Genbubix yupexaenusx. Kopmopauus Humana, Inc., Hanpumep, wanecTHa ‘CBOMM TONHbIM onpenlenennen HitTepBa- Jia BpeMeNH BILIOTS 10 ceKyHU, Paspe- lulueMoro Wa JOCTABKy THUIM H3 KKH K noctes# GonbHoro nomsseKNe MesH= ‘uucxofl cecrpBt nocne Toro, Kax Gonb- ‘Mom waka xHonky 3BonKa. Teneps, Kor~ aa Ys Gosibunsbix KoeK » CLA nycty- eT H3-3a WBOLITOMNOTO cTPOHTeMLCTBAH cw npasHTemscTea coKpaTHTs pac- Xombt, Bce Gobiuust YesanBatoT ypoKit KOMMep¥ecKOro Nomxoda K OpraHNsa- ‘ust cBoefi paGor MIME CHeUMaIBHBIM CTPAXOBLIM TOs com. Une Gompumn, cnenyiousix ux cero BOMMAEMAR rinata oscayeKy- BAHME ‘scnomora- TENbHBIE angel OBchY>KY. BAHMA eS ee ee 50 100 a er.) CTOMMOCTE COREPKAHMA ORHOTO BONBHOTO B AEHB, ONDA, 350 PACXOf[bI M BSVMAEMAA NNATA s ConbHuuax, npHHaAnexauyx nanwKaM (6 yeTe), WB HeKoMMepYeckux ConsHMYax. CpasHeHWe NPOBOAUTCA Ha OcHOBE AaH- Hn NO napa GonbHuy, OAHOR HeKOMMepNeCKOH M BTOPOA, NuHaBNemal\en Nay lyakam, KoTOpeIe CONOCTaBUMBI NO TaKKM apaMeTpam, Kak reorpacbAyeckoe pacno- nomenne, pasMepsl, xapaKTep oGcnyKHBAHAA M APyTHM NoKasaTenAM. CDepHARCTO- lumocTe neveHMA ofHoro GonbHoro B CYTKH Gbina BbIMe B GonBHMYAX, npHHapnera- x namtuiKam. Paspeie COXPaHAeTcA M MpH CONOCTABNeHMM OTHOWeHAR saTpAT K CTOMMOCTH OBchy>KUBaHUG UW CTOMMOCTH ACOMOraTeNbHEIX YCRYT, HANGHMED, Ta kux, Kak NposeneHve NPOYeAYP M BBigaYa neKapcTs. Pasnuuwe RaeT OcHOBAHKE Apepnonarate, 4ro ConbHMUI, NPHHEANEKaMME NaAwNKAM, paGOTAIOT MeHee ad>- cbentusno. YnoMAnyTbie cTaywoHape! BINMAIOT TaKOKE C OONHbIX OSnEUYWO NNATY, MeM HeKOMMeDECKHe YUPEKAEHMA, 6 YACTHOCTH, 3a BCNOMOFATeNbHbIe BABI YCNYT, TO AaeT BOSMOMHOCTE KOMMEDYECKHM GONBHMLJaM NONy'aTk NPHObINe, HECMOTPR Ha ux MeHBuyIO ochcbeKTHBHOCTS. CpasHuTensHbiM aHanus, npoBegeHHeiA M. Yor- ‘Tom, P. Llepsotiom i fx. Xaliom 3 KOHCyNbTaTHBHoM cbypMt Lewin and Associates, Inc. w rpynnoa coTpyAHMKos YuMsepcureTa f»xoKca Tonkwlca, OCHOBaK Ha cono: crasneHnn jannbix 3a 1978-1980 rr. Mocne aToro npaBuTeNscTeO M YaCTHBIe CTpa- xoBbie KOMNaHMW BBeNM MePb NO CRepxMBAKiNO PacKOAOB; COrnacHO HOBOMY ond: >KEHUO, Ic>DEKTHBHOCTS AEATENLHOCTH NOOUIPRETCA BOSHarpaKAeHHEM, OMMEPYECKHE Kopriopaniin cust -Taior, To ux GombHMUBL ynpaBs- rorex Gonee >PexTHBHO, eM HeKOM- Mepueckie CTAUNOHApEI, H_NTO y MUX kaxsealt saTpavenmeit Nonaap Ayame ‘oGecneven o6cayaupannen. Pesynsra- ‘Ter Gonbusuicrea v3 13 nposeneHBix Hecnenonannit He NOATBEp:KAAIOT TOT éaxr. B nanGonee n3pecTHoM Hccen0- anus M. Yor, P. epsom u IbK. Xai 3 dupyut Lewin and Associates. Inc. wccnenosarenn 3 Yawsepenrera Zbxoxca Tonxusica npowssest cono- crasnenne 80 Gonbunu, mpunannexa- oWx nafiupiKam, © TakHM Ke wuCAOM HeKOMMepYECKHX GOMBHBIL MPHMEpHO PAbHEIMM yenoBHaMH reorpaddeckoro Pacnonoxenna, macurraGos sexTenb- HOCTH, KOMMMIeKCOM cnyx6 H cny¥aes saGonenanis. B 1978 1 1980 rr., no Ko- ‘TopsiM NpoBomNOcs conocTasseHe, Gosbumuax, npmHantexanux nafuu- kam, pacxoabt Hla OAWOrO rocrHTaLt3H- PosanHoro Gombworo # jeHs Goi Ebi le NO Beem KaTerOpHAM, KPOME 9KC~ nyaraunomntix pacxonos. HanGone- lee pacxoxknenne, Kax Gb1 CTpAHHBIM 9TO HM nOKasanoce, OGuapy>KWIOce B BeANMHHe HakNAAMbIX pacxonOB, KOTO- ble B KOMMepYeckHIX GomIbHIIAX B cpemt- Hem cocTanitnit #a 57% Gosiutie, Hen B HeKoMMepuecknx. Cneayer OTMeTHTh, ato 83% pasuvust B noxasaTenax npH- xomWTes Ha pacxomb!, NPOMSBesTeHHEIE B canux usra6-xeaptupax. Kopnopari nix cerell. B To xe camoe pena oGcmtenyembie KomMepweckwe GouibHHust BsHMATH ¢ Gomsusix 3HauNTenbHo GonbUtyIo na- ‘Ty, HeM HeKOMMepNecKite CTauHoHapst: 8 cpeanent wa 22% Combine Ha Kaxalyio rocniranusauitio. Pactenkw Ha oGcay- skupaunie Gonbubix He uMenH cyulecT- eHHBIX OTANI B TEX H JIPYFHX YEE AeHUAX; pasHMua B NOKA3aTeNAX OOEAC- ngeTes Gonee BEICOKOM cToUMoCTHIO BenoMoraresLiMbIx npouenyp Hse KapeTBeHHBIx cpeseTs B Gombunuax, Apuwannexaunx nafiuwxas. Flocie MCT MAJIOTOB, BSHMAEMBIX C KOMMEP- Mecknx Gombilt, NOKePTBOBANNA cyGcuauii, nionyyaenbix HeKommepye- ckuMH GombHHuaMH, HcenenoBaTenH NpyLAN K BbIBOAY, WTO HNCTBIM 20xo Gomsann, npunantexauux nafuian, bite Ha 10% Ha KofiKy B AeHs. JToro aocrarouno, 4To6M caenaTt ux Gonee ApxGuutbsbMM npesinpusrTHaNH, eM HeKoMMepyeckHe GosBHMMB!, HeCMOTDA a Gone BBICOKHe pacxomsI, KOTOPBIE ‘on ecyt. Cucrema gunaxcuposauna sapavo- oxpanensia » CIIA witkoraa He cTuMy- Auposana nosimienne sdextusHocTH ReATeMbHOCTH neveOHEIX yupexaCiIAi, ‘TaK Kak ce pacxomlst Gonbuntt WH BbI- NcaHHble K On1aTe c¥eTa KOMNEHCHpO- wanuch. B seficTauTesIbHOCTH TaKas cHt- crema oGyciomnusana cuwxeune >)-KOPNOPALMM 3PABOOXPAHEHMA B CLA 13 SexruonocTu: cHiDKeHHE pacxoOE HK cTONMOCTH c¥eTOR mpHBOANUIO x Gone mixoMy BosMeueHitio H noTOMy nocTe- AYIOUINE yoemueNHA pacxon0B Gui10 ‘Tpynno oGocHosars. Sxppexrusio eM- crayromtas Gombamua akTHYeCKH canta aararupana Ha cebe dutianconyto neT- mio, Tenepb, Kora Gnaronaps Mepam no cnepreimaniio pacxosios Gyaer ni0- -nosxeH KOHeM Gesrpainistomy BosMeue- illo pacxOs10B, KOMMEPHECKHIM KOPNIO- paunass norpeGyeres oBecrewuTh TaKOR BBICORNI! yporcH XbdexTHBHOCTH, KO- Topuitl nos cuAy AMI MPH cHOKHOR ympannenueckotl erpyKtype. Tip oreyrereun noGyanrenpesix MoruBox x coKpallettio pacxowto8 ser- KO NOHATL, NOweMy HeoaHOKpATHBIe O6- suet TOM, WTO KOMMepseCKHE KOP- nopauun He oecneamaloT aocTaToN- Noro Kavectoa oGcayxiRAHW, He Ha- WAH rlosrrHepxneHHR B perynbTaTax ect HecienonaHnit no ITHM BONpO- cam. Hanpisep, B KoMMepYeCKHX Got Max, —OXBaeHHMBIX MecnesOBANHEM Yorra, paGorano Ha 13M Mewbue nep- cowana Ha omit cKoppexTHposauttht ‘Reb MpeOkIBaHA GosibHOrO Ha KORKe, eM B HexomMepweckirx GOmBNNNAX, HO sinners! coTpyniuKam 8 piste 3apa- GorwoH sate! m pasmuaMbix aonaaT Gaim va 10% Gonbune. TlousTHo, To Gonee seicoxne sapaGorKt npnaneKaioT PAGOTHHKOR, ub BBICOKHE MpodpeccHo- anbuuie KadectBa ¢ sIIXBOM! KOMeHCH- PYIOT Hx MponopuMOHabHO MeMBILy#0 ncnenocts. B npouecce apyrux nccne- aopaniif GbinN uay¥eNst TaKHe KpuETe- Du KavecTBa, Kak NoKavaTesb cmepT- nocTH 1 nputssinst GoneaHelt, seposT- Nocrs e6pexxioro evens, cTenen aopepisi GonbHbIX x aHHOH Comba H ‘OTHociTensHoe siKsI0 ANn.TONMPOBAH- bix cleuuannictoa 8 urrate Gokul, npwuiaaiexauix naiuinKans WB HeKOM- Mepweckiix craunovapax. B otnem MbIx NoKasaTenaX BbisaneHtLi He6onb- we pasa, Ho 8 ueTOM oGa THN Gonsin Guim npysnanss conocTasH- Kauecrso — tpyano onpestenemoe HOHNTHIe, B KOTOPOE Paste MOAN BKA- abinaior HeoANHaKOBHait cMbicm; NOTO- My He Bce COMMENT ynza10ck pacceRTs. Hanpuntep, veayt su cea KomMepse- cane GonbHnust Mewiee OTBETCTHEHHO 8 “Tex caIy¥asx, KOrZHa B ropone 1 OKPyTE wet apyrix crauuonapos? oxasa- ‘TesLCTR TOMY, HTO ITO TAK, HET, HO BCH: HE MOMBICHBL H MpeANOAOKEHHK MpO- aonxaiot uMeTb mecto. Bropoll Mo- Meir, sbrabinaiouuil! GecnoxoncTBO, cama c no3arpaxkaeHisMit, KOTOPHIE npeanpummsnsa Gombunia —MoxeT NpeMIOxHT® WITATHBIM spavaM 8 Ka- weeTae noByauTeNbiOro CTUMYsIa 218 oxpauen Pacxonos im yemIveHiA toxoa10B. Ho cux nop wut pasy cuibKeHHe awectna OGemyxiBANHR He OTHOCHLAH a cer 9TOH Mepsi, oHaKo Meswuuti- CKHA HHCTHTYT JanBun, TO MOLOGHBIH nia BosHarpaxKaeHuh MoxeT noKone- Garb oGasarensersa spavei steficTBO- BaTb 8 uMTepecax cBoNX GOMIBHBIX. MuoxecTao npHMepos sloxasbisaer, To KOFMa KOMMepeckas Kopmopaulis noxynaeT HeGombuyi0 nonaBily!o B 3a- TpyaHHTenbHOe diHaHICOBoE nosTOKe- ve Gosantuy, To Ka4ectBo OGcayakHBA- ua yayuutaeTes. B HexOTOpBIX chywasx xopnopauys cnacana Gonsuuny oT pasopeniia ms Gosbulem wucme apyrix cnyvaes — 3aTpawusana —orpombie cpenctra wa o6NoBNeNME HoMeNteHHit 1 ‘oGpyaonanus. illenpete nepewncnenna no nporpammam «Medicare» «Medicaid» 8 casaH ¢ mpouenTantn no aaaoxeHHOCTH, BOIMeMIEHHEM OXON Ma AKUIMM H AMOpTHGAMNeM nosBomUT ‘ocyulecTauTe nepeson Gonemioft wacTH cTOMMOCTH Ha cYeT HanoronsaTENbUIN kop. CucTema HeorpannvenHoro Bo3Me- injeusi Pacxonos nloxpstsarta ApyrHe 32- ‘paral # lapaza Kopnopaunn BO3MOx- HOCTb HaHHMAT! ONMITHbII mepcoHalt 1 NOBbILLIATE ypOBeHb ynpaBieHNa Conb- niumell. iccneaosanue, mposeacnoe C. Uloprennem 113 Cesepo-3anaanoro yuiipepewTera, 1loxasasto, #70 Kopnopa- oxon 3A ron YPOBEHE BEAHOCTH (10610 gonn) cTanpart uac BOSMEWEHME PACKOAOB cTaHaaPT HYDKA. roulnxca BMEnM: YMHCKOR Tomouw casas gonny CTAHAAPT ncan (408 nonin) ‘OMHOKME ‘B3POCNEIE, BESMETHBIE cynpyrn 4 PogMTENn 8 ROMHOUEHHEIK MPOFPAMMD! «Medicare» 1 «Medicaid» onnawunaioT mequ4UncKMe pacxonel 50% Geqneix. pneenennbie TpeGoBannA, KOTOPBIM JOMKHO OTBEUATS NONOKeHHE ‘TaKHx OONBHbIX, NAAT! B Tare ONOPHAa; YPOBHH AOxOAA yKAsaHe! ANACEMEH M3 verbipex WenoBeK 8 1984 r. To nporpawMe «Medicare» (cepeilt yaeT) MenMUMHCKMe pacxogel onnaunBaoTca npectapentim, cnenbiM 4 MHBaNWlaM HEsaBHCHMO OT YPOB- HA wx ROxopa, ano nporpamme «Medicaids (a yeere) neroTamm nonbsyioTcA ceMbM C OAHHM poRuTeneM n GepeMeHHbie aKeHWWHE!, YORE AOxoAa y KOTOPEIX (nocne Onpepenevibix BbINeTOR) OnyCKAeTCA NO MN MuDKe CTaNAapTHOM BeNMuMtH! AOXO- Aa, YCTAHOBNeHHOTO NPOTPAMMOM NOMOWIM CEMBAM C ReTEMM-WKQUBeHUAMM (CAM). (B kaxgoM wrare ZeAcTeylT CBOM CTAHAAPTbI, KOTOPBIE OObI4HO SHANN- TenbHo HUME NPUHRTOrO ypOBHA Ce_HocTH.) TlonyYa‘ouNe NoMOe Mo NporpaMMe «Medicare» TaioKe uMeIoT Npago Ha NOAAEPxKy ® pawKax NporpaMms! «Medicaid», Ch YPOBEHb Ux AOXOMla CTAHOBUTCA HMXKe CTaHAapTa, NPERYCMOTPeHHOrO NpO- FpaMMOA AONONHHTeNbHOro CrpaxoeaHma (IAC). B 3TOM cnyuae «Medicaid» sosme- aer pacxonsi Ha yenyrn, He oxaauenHbie «Medicare». Bo Onopwpe, KaK u BO MHOrUX APYTHK wraTax, nbroTeI no «Medicaid» pacnpoctpaHmoToA u Ha AeTeA, W Ha Oespi GOTHEIX POAMTENEM B NONHOYEHHEIX CeMbAX C YPOBHEM AOxoRa HwKe CTaHpapTé TICAM. 6 Hen taKxKe npeaycMoTpeH (boHA «HanMuHoro OBecneveHHA PacKoAOR», B pankax KOToporo OnpeReNeHHble CeMBM MOryT COpaulaTECA 3a NOMOWIbIO NO NKHMM «Medicaid», ecni saTparel Ha neveHve CHWSUNM ypoBeH® wx ROXORa AO craHpapta Hy KAAIOWWXCAB MEAMUWHCKOR NlOMOU» HM ee H¥DKe. Tem He Meee MHOrHe OeR- AK, NPORHBaIOMNE BO ONOPMAE 4 APYTHX WTATAX, BbIMyAKAeHEINPHOETATS K NOMO- Ww Ans GeaHLIK, MPEROCTABNREMOA COWECTEEHHEIMH KM YACTHBINN CONbHHYEMN. Qwarpamma noctpoevia Ha ocHose AaHbix, npegocTasneHHeix cbupMon Lewin and Associates, Inc.