American Enterprise Institute for Public Policy Research, Washington, DC, USA.
Am J Manag Care. 2010 Nov;16(11):804-12.
In September 2009, we released a set of concrete, feasible steps that could achieve the goal of significantly slowing spending growth while improving the quality of care. We stand by these recommendations, but they need to be updated in light of the new Patient Protection and Affordable Care Act (ACA). Reducing healthcare spending growth remains an urgent and unresolved issue, especially as the ACA expands insurance coverage to 32 million more Americans. Some of our reform recommendations were addressed completely or partially in ACA, and others were not. While more should be done legislatively, the current reform legislation includes important opportunities that will require decisive steps in regulation and execution to fulfill their potential for curbing spending growth. Executing these steps will not be automatic or easy. Yet doing so can achieve a healthcare system based on evidence, meaningful choice, balance between regulation and market forces, and collaboration that will benefit patients and the economy (see Appendix A for a description of these key themes). We focus on three concrete objectives to be reached within the next five years to achieve savings while improving quality across the health system: 1. Speed payment reforms away from traditional volume-based payment systems so that most health payments in this country align better with quality and efficiency. 2. Implement health insurance exchanges and other insurance reforms in ways that assure most Americans are rewarded with substantial savings when they choose plans that offer higher quality care at lower premiums. 3. Reform coverage so that most Americans can save money and obtain other meaningful benefits when they make decisions that improve their health and reduce costs. We believe these are feasible objectives with much progress possible even without further legislation (see Appendix B for a listing of recommendations). However, additional legislation is still needed to support consumers – including Medicare beneficiaries – in making choices that reduce costs while improving health.
2009 年 9 月，我们提出了一系列具体可行的步骤，可以实现大幅减缓支出增长速度、同时提高医疗质量的目标。我们仍然支持这些建议，但鉴于《患者保护与平价医疗法案》（ACA）的颁布，这些建议需要更新。降低医疗支出的增长速度仍然是一个紧迫而未解决的问题，特别是随着 ACA 将保险范围扩大到另外 3200 万美国人。我们的一些改革建议在 ACA 中得到了完全或部分落实，而另一些则没有。虽然还需要在立法方面做更多的工作，但目前的改革立法包含了重要的机会，需要在监管和执行方面采取果断措施，以充分发挥其控制支出增长的潜力。这些步骤的执行不会是自动或容易的。然而，这样做可以建立一个基于证据、有实际意义的选择、在监管和市场力量之间取得平衡以及促进合作的医疗体系，使患者和经济受益（见附录 A，其中描述了这些关键主题）。我们专注于在未来五年内实现以下三个具体目标，以在提高整个医疗体系质量的同时实现节省：1. 加快支付改革，摆脱传统的基于数量的支付体系，使这个国家的大部分医疗支付更符合质量和效率。2. 以确保大多数美国人在选择提供更高质量护理、更低保费的计划时获得大量节省的方式实施医疗保险交易所和其他保险改革。3. 改革覆盖范围，使大多数美国人在做出改善健康和降低成本的决策时能够节省资金并获得其他有意义的福利。我们相信这些是可行的目标，即使没有进一步的立法，也可以取得很大进展（见附录 B，其中列出了建议）。然而，仍然需要更多的立法来支持消费者——包括医疗保险受益人——在做出降低成本同时改善健康的选择。
