Bessler J S, Ellies M
Booz-Allen & Hamilton (Australia) Limited.
Aust Health Rev. 1995;18(3):6-17; discussion 18-29.
The Australian health care system is at a crossroads. Status quo is not a sustainable option for the future. Rising consumption, spiralling costs, the decline of private health insurance and a public sector 'bursting at the seams' threaten our traditional values of a universal, affordable, accessible, equitable, high-quality system. As a result, we believe that major reform of the health care system is both necessary and inevitable in order to ensure that the values of the system are maintained and to extract maximum value from limited health resources. In this article we lay out our vision for the Australian health care system. It is a vision characterised by transformational change--shifting of risk from patients and taxpayers to providers, downsizing of acute care capacity, integration of services across the system, rationalisation of State and Federal responsibilities and a 'shakeout' of providers and insurers resulting from intensified, but bounded, competition. We believe that the direction for health care players needs to be clarified so that, as a country, we can continue to have a best practice model of health care delivery. We present this vision as a 'stake in the ground' to set parameters around which this debate can emerge. It may be provocative and challenging, but it is our vision into the future.
澳大利亚医疗体系正处于十字路口。维持现状并非未来可持续的选择。消费不断增长、成本急剧上升、私人医疗保险下滑以及公共部门“不堪重负”，都对我们全民覆盖、价格可承受、可及、公平、高质量医疗体系的传统价值观构成威胁。因此，我们认为，为确保该体系的价值观得以维系，并从有限的医疗资源中获取最大价值，医疗体系的重大改革既必要又势在必行。在本文中，我们阐述了对澳大利亚医疗体系的愿景。这一愿景的特点是变革性变化——将风险从患者和纳税人转移至医疗服务提供者，缩减急症护理能力，整合全体系的服务，合理划分州和联邦的职责，以及因激烈但有限的竞争导致医疗服务提供者和保险公司的“洗牌”。我们认为，需要明确医疗行业参与者的方向，这样，作为一个国家，我们才能继续拥有最佳的医疗服务提供模式。我们提出这一愿景作为“基本立场”，为这场辩论设定参数。它可能具有挑衅性和挑战性，但这是我们对未来的愿景。
