Center for Bioethics, Health & Society, Wake Forest University, Winston-Salem, NC 27157-1063, USA.
J Gen Intern Med. 2011 Jul;26(7):802-5. doi: 10.1007/s11606-011-1654-4. Epub 2011 Mar 26.
National health insurance reform will pose considerable challenges to the core missions of safety net organizations that serve the uninsured. Those who currently donate money or time will, rightly or wrongly, view uninsured recipients as less deserving on the whole. Nevertheless, safety net organizations can serve several critical functions that continue to justify their existence and support.One important mission is to maintain access for low-income uninsured until all elements of insurance reform are fully in place. Second, once the reform is implemented, people will need a great deal of assistance and encouragement to determine what they are supposed to do and where they are supposed to sign up. Third, substantial portions of the remaining uninsured will continue to lack affordable insurance options, and large numbers of people eligible for coverage will unavoidably undergo temporary gaps in coverage as their family and financial circumstances change. Finally, not all people with insurance will have affordable access to all needed care. Market conditions will continue pushing higher levels of patient cost-sharing through deductibles and co-payments.To serve these multiple needs, safety net organizations should consider adapting their missions and business models so that they accept both insured and uninsured patients under a sliding fee scale that varies charges according to ability to pay.
国家医疗保险改革将给为无保险人群服务的医保服务机构的核心使命带来巨大挑战。那些目前捐赠金钱或时间的人，无论正确与否，可能会整体上认为无保险的接受者不太值得。尽管如此，医保服务机构可以发挥几个关键作用，这仍然证明了它们的存在和支持是合理的。一个重要使命是维持为低收入无保险人群提供服务，直到保险改革的所有要素完全到位。其次，一旦改革实施，人们将需要大量的帮助和鼓励，以确定他们应该做什么，以及他们应该在哪里注册。第三，大量剩余的无保险人群将继续缺乏负担得起的保险选择，而大量有资格获得保险的人，由于家庭和财务状况的变化，不可避免地会经历临时的保险中断。最后，并非所有有保险的人都能负担得起所有必要的护理。市场状况将继续通过免赔额和共同支付来推动更高水平的患者自付费用。为了满足这些多种需求，医保服务机构应该考虑调整其使命和商业模式，以便根据支付能力，通过浮动费用表来接受有保险和无保险的患者。
