Rochefort D A
Northeastern University, Boston, Massachusetts 02115.
Hosp Community Psychiatry. 1992 Nov;43(11):1083-90. doi: 10.1176/ps.43.11.1083.
Many health policy reformers and researchers in the United States have focused on the Canadian health care system and its lessons for design of a national health care program in the U.S. Yet minimal attention has been given to Canadian mental health policy in this discussion. The author reviews the historical development of mental health services in Canada and discusses five current sources of tension in Canada's mental health care system, many of which are familiar to the American setting: restriction on fee-for-service payments, a two-tiered pattern of care involving provincial mental hospitals and general hospital psychiatric units, shortages of mental health care resources, limited funding of community-based programs, and lack of coordination of care. The author concludes that universal insurance coverage patterned after the Canadian model would ameliorate only some problems faced by mentally ill persons in the United States. Mental health benefits must be structured to ensure the availability and organization of a full spectrum of long-term health care and supportive services.
美国许多医疗政策改革者和研究人员关注加拿大医疗体系及其为美国国家医疗计划设计提供的经验教训。然而，在这场讨论中，加拿大心理健康政策却很少受到关注。作者回顾了加拿大心理健康服务的历史发展，并探讨了加拿大心理健康护理体系当前存在的五个紧张根源，其中许多在美国背景下也很常见：对按服务收费支付的限制、涉及省级精神病院和综合医院精神科病房的两层护理模式、心理健康护理资源短缺、社区项目资金有限以及护理缺乏协调。作者得出结论，效仿加拿大模式的全民保险覆盖只会缓解美国精神病患者面临的一些问题。必须构建心理健康福利，以确保提供全方位的长期医疗保健和支持性服务，并保证其组织有序。
