10年后的健康保障法失败:随后的发展和持续的问题
1Edward E. and Helen T. Bartlett Foundation Chair in Public Health, Department of Health Administration and Policy, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City 73104-5072, USA. peter-budetti@ouhsc.edu
JAMA
|October 28, 2004
概括
在健康保障法案 (HSA) 失败十年后,美国医疗保健面临着持续的问题,如无保险和不断上升的成本. 需要进行全面的改革,整合普遍覆盖,质量和成本控制,以实现合理的方法.
科学领域:
- 卫生政策与经济 卫生政策与经济
- 医疗保健系统分析 医疗保健系统分析
- 公共卫生挑战 公共卫生挑战
背景情况:
- 美国医疗保健系统继续经历重大压力,包括大量没有保险的人口,不断上升的成本,质量问题和管理护理不满.
- 在健康保障法 (HSA) 失败十年后,无论是逐步的立法变化还是私营部门的调整,都没有解决这些持久的问题,新的问题正在出现.
研究的目的:
- 以HSA的框架来追踪美国医疗保健系统在HSA后的演变和当前状况.
- 概述所吸取的经验教训,并指导医疗改革的未来行动.
- 强调需要对全面医疗保健改革有一个明确的愿景.
主要方法:
- 分析过去十年来美国医疗保健系统的演变.
- 评估增量立法和私营部门变化的影响.
- 基于"健康保障法" (HSA) 关键组成部分的框架分析:全民覆盖,管理竞争,低收入保险和患者权利.
主要成果:
- 渐进的立法和私营部门的变化未能改善HSA旨在解决的核心问题.
- 新的医疗保健挑战已经出现,影响所有人口群体,导致医疗保健的恶化.
- 尽管存在持续的问题,但对大规模医疗保健改革缺乏政治支持.
结论:
- 未来行动的核心组成部分必须包括普遍覆盖,质量改善,成本控制和对弱势群体的补贴.
- 一个清晰的,统一的愿景是必要的,以连接增量步骤为全面医疗改革的合理战略.
- 迈向实现这样的愿景是美国医疗保健系统的迫切需要.
关键词:
医疗保健和公共卫生
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