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利还是没有利? 从保险前线的经验可以吸取教训
1Paula A. Steiner (PaulaASteiner@gmail.com) is the former CEO of the Health Care Service Corporation, in Chicago, Illinois. The opinions expressed are those of the author and do not necessarily reflect those of the Blue Cross Blue Shield Association or its member plans. To access the author's disclosures, click on the Details tab of the article online.
Health affairs (Project Hope)
|November 6, 2023
概括
无论是营利性还是非营利性医疗保险模式,都不能完全满足医疗保健需求. 本文探讨了医疗保健融资和提供持续存在的差距,寻求更好的患者护理解决方案.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗保健经济学 医疗经济学
- 卫生政策分析 卫生政策分析
背景情况:
- 当前的医疗保健系统在实现预期结果方面面临着持续的挑战.
- 从历史上看,营利性和非营利性保险模式都在努力满足所有利益相关者的期望.
- 要了解这些缺陷,需要对医疗保健融资进行批判性审查.
研究的目的:
- 分析现有的医疗保健融资结构为何无法实现预期的医疗保健目标的根本原因.
- 思考医疗保健中营利性和非营利性保险模式的局限性.
- 确定医疗保健提供和融资的潜在改进领域.
主要方法:
- 基于医疗保险行业高管经验的定性反思.
- 分析不同医疗保健融资模式的历史表现和结果.
- 医疗保健经济学和政策原则的概念审查.
主要成果:
- 无论是营利性还是非营利性保险结构,都没有成功地弥合了医疗保健成本和患者期望的结果之间的差距.
- 医疗保健融资中的系统性问题阻碍了提供全面和负担得起的医疗保健.
- 这位高管的观点强调了超越传统模式的创新方法的需要.
结论:
- 医疗保健融资的根本性改革是必要的,以实现所需的患者护理.
- 现有的保险框架需要重新评估,以解决医疗保健部门未得到满足的需求.
- 未来的医疗保健解决方案可能需要超越营利与非营利的二分法.
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