将保险覆盖转化为优质的医疗保健:电压从潜在下降到提供质量的质量下降
1Agency for Healthcare Research and Quality, Department of Health and Human Services, 2101 E Jefferson St, Rockville, MD 20852, USA. jeisenbe@ahrq.gov
JAMA
|October 24, 2000
概括
确保美国高质量的医疗保健需要解决超出保险范围的脆弱性. 在获得护理,选择提供者以及获得一致的初级和转诊服务方面存在差距.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生政策 公共卫生政策
- 医疗保健的不平等 医疗保健的不平等
背景情况:
- 美国医疗保健系统在人口,地区和机构的医疗保健质量方面面临着显著的差异.
- 医疗保险倡议旨在改善医疗接入,但不能保证高质量的医疗保健结果.
- 了解系统性弱点对于改善医疗保健提供至关重要.
研究的目的:
- 为了确定美国医疗保健系统中的关键弱点,即高质量护理的实现受到损害.
- 分析从保险覆盖到提供医疗保健服务的链接.
主要方法:
- 医疗保健提供途径的概念分析.
- 识别系统中七个关键的"电压下降"或故障点.
- 审查影响获得保险,入学,服务和持续护理的因素.
主要成果:
- 发现的漏洞包括:获得保险,计划入学,获得覆盖服务和提供者,计划和提供者的选择,一致的初级保健服务,转诊服务和医疗保健服务质量.
- 每个确定的"电压下降"都代表了实现高质量护理的潜在损失点.
- 仅靠保险覆盖就不足以确保优质的护理.
结论:
- 解决系统性"电压下降"对于确保所有美国人获得高质量的医疗保健至关重要.
- 政策和实践必须侧重于改善多个阶段的访问,从覆盖范围到服务提供.
- 需要采取全面的方法来克服医疗保健差异,提高整体医疗保健质量.
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