Ross Joseph S, Detsky Allan S
Department of Geriatrics and Palliative Care, Mount Sinai School of Medicine, New York, New York, USA.
JAMA. 2009 Oct 28;302(16):1803-4. doi: 10.1001/jama.2009.1566.
Media speculation about the scope of proposals for health care reform in the United States have led many Americans to be “very concerned” that changes will limit their choices in the future (ABC news poll 6/24/09). Health care choices are made on three levels: insurance plans, sources of care (physicians and hospitals), and clinical decisions (diagnostic tests and treatments). In this Commentary, we discuss the extent to which Americans currently are able to exercise choices. For context, we will compare the U.S. environment with that in Canada, partly because its health system, with much greater government involvement, is often publicly-portrayed in the U.S. as limiting choice.
美国媒体对医疗保健改革提案范围的猜测，致使许多美国人“深感担忧”，担心改革会在未来限制他们的选择（美国广播公司新闻民意调查，2009年6月24日）。医疗保健选择在三个层面上进行：保险计划、医疗服务来源（医生和医院）以及临床决策（诊断测试和治疗）。在本评论中，我们将探讨美国人目前能够行使选择权的程度。作为背景，我们将美国的情况与加拿大进行比较，部分原因是加拿大的医疗体系有更多政府参与，在美国公众眼中它常常被描绘为限制了选择。
