Lee K J, Lee M E
Yale University School of Medicine, USA.
Conn Med. 2000 Aug;64(8):485-91.
One problem with the American health-care system today is not that it's too expensive but that it's too wasteful. The amount spent on health-care in the United States is sufficient to take care of the medical needs of every citizen. The reason that it does not is that the money is far too often is misspent. America already is spending 14% of the gross domestic product and yet we have health-care chaos and 44 million uninsured. Another problem is the lack of trust between payors, insurance carriers, regulators, employers, employees, providers, and patients. Although the financing aspect of health-care is tremendously important, it is even more important to design a plan to spend the money wisely, align the incentives of insurers, payors, patients, and providers, and restore trust between parties. Otherwise we shall continue to be in chaos regardless of how much money we spend on health-care. In this article, we outline our proposal for an ideal comprehensive national health-care plan that will guarantee that we spend our health-care dollars wisely. Our plan would cover all Americans, including the 44 million uninsured, and it would do so at less than the cost of the current system. Because insurance companies are not equipped to oversee medical practice, our plan would place the day-to-day management of the health-care system in the hands of physicians and local physician-run, physician-owned "provider groups." The physicians in these provider groups would be charged with two primary responsibilities: 1) clinically, they would be responsible for providing total quality cradle-to-grave health-care for every patient in their group and 2) economically, they would be responsible for the budget and to spend it wisely. Physicians will be compensated fee-for-service plus an incentive for efficiency, patient satisfaction, and outcome in a broad sense. Physicians would enjoy wide latitude in clinical decision-making without being second-guessed by distant third parties. Our plan places the fiscal responsibility on physicians while at the same time establishing a system of checks and balances to ensure that patients are protected and well cared for. Unlike outwardly similar plans, under this proposal the physicians are owners of the provider groups and the incentives between payors, insurers, providers, and patients are better aligned. It will eliminate the debate about giving patients the right to sue health plans and employers. It would empower large legally organized physician groups to negotiate with insurers. Our plan is a model for spending money wisely. We believe it would benefit, and therefore be embraced, by all parties--physicians, other healthcare providers, employers, insurance companies, the government, and above all the American public.
如今美国医疗保健系统存在的一个问题并非费用过高，而是浪费严重。美国在医疗保健方面的支出足以满足每个公民的医疗需求。但实际并非如此，原因在于这些资金常常被滥用。美国已经将国内生产总值的14%用于医疗保健，然而我们却面临医疗保健混乱的局面，还有4400万人没有医疗保险。另一个问题是付款方、保险公司、监管机构、雇主、雇员、医疗服务提供者和患者之间缺乏信任。尽管医疗保健的融资方面极为重要，但更重要的是制定一个明智使用资金的计划，调整保险公司、付款方、患者和医疗服务提供者的激励机制，并恢复各方之间的信任。否则，无论我们在医疗保健上花费多少钱，我们都将继续处于混乱状态。在本文中，我们概述了我们对于一个理想的全面国家医疗保健计划的提议，该计划将确保我们明智地使用医疗保健资金。我们的计划将覆盖所有美国人，包括4400万未参保者，而且其成本将低于现行系统。由于保险公司没有能力监督医疗实践，我们的计划将把医疗保健系统的日常管理交给医生以及由当地医生运营、医生所有的“医疗服务提供团体”。这些医疗服务提供团体中的医生将承担两项主要职责：1）在临床方面，他们要负责为团体中的每位患者提供从摇篮到坟墓的全面优质医疗保健服务；2）在经济方面，他们要负责预算并明智地使用预算。医生将按服务收费，并获得提高效率、患者满意度以及广义上的治疗效果的激励。医生在临床决策方面将拥有广泛的自主权，不会受到遥远第三方的无端质疑。我们的计划将财政责任赋予医生，同时建立一个制衡系统，以确保患者得到保护并得到妥善照料。与表面上类似的计划不同，根据这一提议，医生是医疗服务提供团体的所有者，付款方、保险公司、医疗服务提供者和患者之间的激励机制得到了更好的调整。它将消除关于赋予患者起诉医疗保健计划和雇主权利的争论。它将授权大型合法组建的医生团体与保险公司进行谈判。我们的计划是明智使用资金的典范。我们相信它将使各方——医生、其他医疗服务提供者、雇主、保险公司、政府，尤其是美国公众——受益，因此会得到各方的接受。
