Beyer David C, Mohideen Najeeb
Arizona Oncology Services, Scottsdale, AZ 85260, USA.
Semin Radiat Oncol. 2008 Jul;18(3):186-93. doi: 10.1016/j.semradonc.2008.01.006.
Health policy is developed in the United States through a complicated interplay of governmental and private agencies and businesses, physician organizations, and societies as well as a host of other private ventures. The end result is rarely precisely what any individual or group may desire as the consequences of any action are never entirely predictable. There are many pathways to influence policy development within this system, and many of these are influenced by physicians as individuals and through organized medical societies. Opportunities abound to constructively engage the system, and it is important that physicians operating within this system understand where and how they may influence policy development. Changes are made or considered on a daily basis that impact patient's access to care, implementation and access to technological and biological innovation, reporting requirements, insurance, physician's reimbursement, and so on. This article reviews the most important channels by which physician input is incorporated in the system. The role of specialty societies, general medical societies, Congress, and Centers for Medicare and Medicaid Services are reviewed. The role of other players will also be addressed to show the many routes by which policy may evolve. Much of the discussion revolves around reimbursement because reimbursement often determines the availability and use of procedures and technology for our patients.
美国卫生政策的制定是通过政府机构、私人机构与企业、医师组织、协会以及许多其他私人企业之间复杂的相互作用来实现的。最终结果很少能完全符合任何个人或团体的期望，因为任何行动的后果都无法完全预测。在这个体系中有许多影响政策制定的途径，其中许多途径受到医师个人以及通过有组织的医学协会的影响。积极参与这个体系的机会很多，在这个体系中运作的医师了解他们在何处以及如何能够影响政策制定非常重要。每天都会做出或考虑一些影响患者获得医疗服务、技术和生物创新的实施与获取、报告要求、保险、医师报销等方面的变革。本文回顾了医师意见被纳入该体系的最重要渠道。审查了专科协会、普通医学协会、国会以及医疗保险和医疗补助服务中心的作用。还将探讨其他参与者的作用，以展示政策可能演变的多种途径。大部分讨论围绕报销展开，因为报销往往决定了我们的患者所能获得的医疗程序和技术以及使用情况。
