American Enterprise Institute, 1150 Seventeenth Street, NW, Washington, DC 20036, USA.
Pharmacoeconomics. 2006 Dec;24 Suppl 2:5-14. doi: 10.2165/00019053-200624002-00002.
The question has been asked about what kind of health reform will occur in the US. Will it be a radical transformation or muddling through? Muddling through in health policy is clearly the approach that is more consistent with American history and political traditions than radical reform. But how, and how fast, we muddle through is itself an interesting question. This paper explores the market and public policy forces that are likely to affect the future of health policy in the US. Will the US follow the example of the European countries by expanding public financing and control, or will it take a different approach based more on consumer choice and provider competition? As background, the paper reviews some important events that shaped the US healthcare system and explains why our current market situation complicates our ability to achieve efficient reform. It also discusses why the future of reform will be strongly influenced by how the market for health insurance develops over the next decade. If the new forms of high deductible, catastrophic plans combined with personal savings accounts meet the market test and are considered successful, this will give policy makers new options for expanding coverage to the uninsured and reforming Medicare and Medicaid. But, as we know from the history of other markets, much can go wrong. Some predictions about the future course of reform are offered.
已经有人提问，美国将进行何种类型的医疗改革？是彻底改革还是摸着石头过河？显然，在医疗政策方面，摸着石头过河的做法比彻底改革更符合美国的历史和政治传统。但是，我们如何以及以多快的速度进行改革本身就是一个有趣的问题。本文探讨了可能影响美国未来医疗政策的市场和公共政策力量。美国是效仿欧洲国家扩大公共筹资和控制，还是采取更多基于消费者选择和提供者竞争的不同方法？作为背景，本文回顾了一些塑造美国医疗保健系统的重要事件，并解释了为什么我们当前的市场状况使我们难以实现有效的改革。本文还讨论了为什么在未来十年内医疗保险市场的发展将强烈影响改革的未来。如果新型高免赔额、灾难性计划与个人储蓄账户相结合的方式符合市场需求并被认为是成功的，那么这将为政策制定者提供扩大对无保险人群的覆盖范围以及改革医疗保险和医疗补助的新选择。但是，正如我们从其他市场的历史中了解到的那样，可能会出现许多问题。本文提供了一些对未来改革进程的预测。
