Silberman Pam
North Carolina Institute of Medicine, Morrisville, North Carolina 27560, USA.
N C Med J. 2013 Jul-Aug;74(4):298-307.
The health insurance mandate, perhaps the best-known provision of the Patient Protection and Affordable Care Act of 2010 (ACA), is slated to go into effect on January 1, 2014. Yet most people do not know how the ACA will affect them. More than one-third of people in a recent national poll were unaware that new health insurance marketplaces will make it easier to purchase coverage or that some people will qualify for subsidies to help them purchase coverage. The ACA includes many other provisions that will have a profound impact on our health care delivery system. Some changes are already helping to break down silos in the delivery of care. Groups of health care professionals are working together to manage the health of populations. The ACA places a much greater emphasis on measuring quality and on paying health professionals and health care institutions based on the value of the services they provide. In addition, the ACA makes greater investments in prevention and in population health management. This issue brief highlights some of the health system changes that have taken place over the past 3 years, as well as some of the potential changes that are yet to come relating to insurance coverage, access to care, quality of care, rising health care costs, and overall population health.
医疗保险强制参保规定或许是2010年《患者保护与平价医疗法案》（ACA）最广为人知的条款，定于2014年1月1日生效。然而，大多数人并不清楚ACA将如何影响他们。在最近一次全国民意调查中，超过三分之一的人不知道新的医疗保险市场将使购买保险更容易，也不知道一些人有资格获得补贴以帮助他们购买保险。ACA还包括许多其他条款，这些条款将对我们的医疗服务体系产生深远影响。一些变革已经有助于打破医疗服务提供中的壁垒。医疗专业人员团队正在共同努力管理人群健康。ACA更加注重衡量医疗质量，并根据医疗专业人员和医疗机构提供服务的价值来支付费用。此外，ACA在预防和人群健康管理方面投入更多。本问题简报重点介绍了过去三年发生的一些医疗体系变革，以及与保险覆盖范围、医疗服务可及性、医疗质量、不断上涨的医疗成本和总体人群健康相关的一些潜在变革。
