Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
Ann Fam Med. 2013 Sep-Oct;11(5):473-6. doi: 10.1370/afm.1541.
In the United States, stable health insurance coverage is associated with improved health outcomes. A lack of insurance is associated with premature death from preventable causes. Although primary care clinicians are often in a position to see firsthand the impact that being uninsured has on patients, most ambulatory care clinics are not actively involved in helping patients obtain health insurance, retain their coverage, or make important health insurance coverage decisions. The magnitude and complexity of the US "uninsurance" problem, as well as recent federal initiatives to expand coverage options, inspire important questions: Can medical homes play a more active role in helping patients find and keep insurance coverage? How can basic tenets from the chronic care model be operationalized to build systems to treat the uninsurance ailment? Creating effective processes and tools within the medical home to keep a patient insured may be as important to improving population health as helping a patient maintain a normal blood pressure. Similar system-level interventions could be used to support both endeavors.
在美国，稳定的医疗保险覆盖与改善健康结果有关。缺乏保险与可预防原因导致的过早死亡有关。尽管初级保健临床医生通常能够直接看到没有保险对患者的影响，但大多数门诊诊所并没有积极参与帮助患者获得医疗保险、保留其保险或做出重要的医疗保险决策。美国“无保险”问题的规模和复杂性，以及最近扩大保险选择的联邦倡议，引发了一些重要问题：医疗之家能否在帮助患者寻找和保持保险覆盖方面发挥更积极的作用？慢性病模式的基本原理如何付诸实施，以建立治疗无保险疾病的系统？在医疗保健机构中创建有效的流程和工具来确保患者的保险，对于改善人口健康可能与帮助患者维持正常血压同样重要。类似的系统干预措施可以用于支持这两个方面的努力。
