Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7080, USA.
Clin Gastroenterol Hepatol. 2009 Nov;7(11):1168-73. doi: 10.1016/j.cgh.2009.07.018. Epub 2009 Jul 22.
The US health care system is characterized by staggering costs alongside limited access, uneven quality, and subpar health outcomes. Although federal policymakers have long acknowledged this health care crisis, there still has been no fundamental realignment in health care organization or delivery. With a new Presidential Administration and deep economic recession, profound changes now appear imminent. These changes are likely to impact gastroenterologists significantly, including who they treat, how they deliver care, and how they are compensated. This article considers the most likely reforms, including health insurance and the drive toward universal coverage; a shift to reimbursement models that reward quality over the entire episode of care; reorganization of health care delivery around more highly integrated practices, patient-centered medical homes, and accountable care organizations; and electronic health records, comparative effectiveness research, and reporting transparency as necessary tools for implementing systemic change. Finally, anticipating these changes, this article concludes with specific recommendations to enable gastroenterologists to adapt to new practice environments.
美国的医疗保健系统以高昂的费用为特征，同时还存在着有限的可及性、不均衡的质量和较差的健康结果。尽管联邦政策制定者长期以来一直承认存在这一医疗保健危机，但在医疗保健组织或服务的提供方面仍未进行根本性的调整。随着新的总统行政当局和严重的经济衰退，深刻的变革似乎迫在眉睫。这些变化可能会对胃肠病学家产生重大影响，包括他们治疗的对象、提供护理的方式以及获得报酬的方式。本文考虑了最有可能的改革，包括医疗保险和实现全民覆盖的动力；转向以整个护理过程的质量为基础的报销模式；围绕更高度整合的实践、以病人为中心的医疗之家和责任制医疗组织来重组医疗服务的提供；以及电子健康记录、比较疗效研究和报告透明度，作为实施系统性变革的必要工具。最后，本文预测了这些变化，并提出了具体建议，以使胃肠病学家能够适应新的实践环境。
