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奥巴马全民医保:实际影响。

Obama health care for all Americans: practical implications.

作者信息

Manchikanti Laxmaiah, Hirsch Joshua A

机构信息

Pain Management Center of Paducah, Paducah, KY 42003, USA.

出版信息

Pain Physician. 2009 Mar-Apr;12(2):289-304.

Abstract

Rapidly rising health care costs over the decades have prompted the application of business practices to medicine with goals of improving the efficiency, restraining expenses, and increasing quality. Average health insurance premiums and individual contributions for family coverage have increased approximately 120% from 1999 to 2008. Health care spending in the United States is stated to exceed 4 times the national defense, despite the wars in Iraq and Afghanistan. The U.S. health care system has been blamed for inefficiencies, excessive administrative expenses, inflated prices, inappropriate waste, and fraud and abuse. While many people lack health insurance, others who do have health insurance allegedly receive care ranging from superb to inexcusable. In criticism of health care in the United States and the focus on savings, methodologists, policy makers, and the public in general seem to ignore the major disadvantages of other global health care systems and the previous experiences of the United States to reform health care. Health care reform is back with the Obama administration with great expectations. It is also believed that for the first time since 1993, momentum is building for policies that would move the United States towards universal health insurance. President Obama has made health care a central part of his domestic agenda, with spending and investments in Children's Health Insurance Program (CHIP), American Recovery and Reinvestment Act of 2009, and proposed 2010 budget. It is the consensus now that since we have a fiscal emergency, Washington is willing to deal with the health care crisis. Many of the groups long opposed to reform, appear to be coming together to accept a major health care reform. Reducing costs is always at the center of any health care debate in the United States. These have been focused on waste, fraud, and abuse; administrative costs; improving the quality with health technology information dissemination; and excessive regulations on the health care industry in the United States. Down payment on health care reform, American Recovery and Reinvestment Act, and CHIP include many provisions to reach towards universal health care.

摘要

几十年来,医疗保健费用的迅速上涨促使人们将商业做法应用于医学领域,目标是提高效率、控制开支并提升质量。从1999年到2008年,平均医疗保险费以及家庭保险的个人缴费增长了约120%。尽管美国在伊拉克和阿富汗打仗,但美国的医疗保健支出据说超过国防支出的四倍。美国医疗保健系统被指责效率低下、行政费用过高、价格虚高、存在不当浪费以及欺诈滥用行为。虽然许多人没有医疗保险,但其他有医疗保险的人据称得到的护理质量参差不齐,有的极好,有的则不可原谅。在美国医疗保健受到批评以及人们关注节省开支的情况下,方法论学者、政策制定者和普通公众似乎忽视了其他全球医疗保健系统的主要弊端以及美国以往医疗保健改革的经验。随着奥巴马政府的上台,人们对医疗保健改革寄予厚望。人们还认为,自1993年以来首次出现了推动美国走向全民医疗保险政策的势头。奥巴马总统已将医疗保健作为其国内议程的核心部分,涉及儿童健康保险计划(CHIP)的支出和投资、《2009年美国复苏与再投资法案》以及2010年预算提案。现在大家的共识是,鉴于我们面临财政紧急情况,华盛顿愿意应对医疗保健危机。许多长期反对改革的团体似乎正在联合起来接受重大的医疗保健改革。降低成本始终是美国任何医疗保健辩论的核心。这些辩论集中在浪费、欺诈和滥用行为、行政成本、通过健康技术信息传播提高质量以及美国对医疗保健行业的过度监管上。医疗保健改革预付款项、《美国复苏与再投资法案》以及儿童健康保险计划包含许多旨在实现全民医疗保健的条款。

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