James Hester (
Health Aff (Millwood). 2018 Apr;37(4):570-578. doi: 10.1377/hlthaff.2017.1237.
A successful strategy for improving population health requires acting in several sectors by implementing a portfolio of interventions. The mix of interventions should be both tailored to meet the community's needs and balanced in several dimensions-for example, time frame, level of risk, and target population. One obstacle is finding sustainable financing for both the interventions and the community infrastructure needed. This article first summarizes Vermont's experience as a laboratory for health reform. It then presents a conceptual model for a community-based population health strategy, using a balanced portfolio and diversified funding approaches. The article then reviews Vermont's population health initiative, including an example of a balanced portfolio and lessons learned from the state's experience.
要想成功改善人口健康状况,就需要在多个部门采取行动,实施一整套干预措施。干预措施的组合既要针对满足社区的需求,又要在多个方面保持平衡,例如时间框架、风险水平和目标人群。其中一个障碍是为干预措施以及所需的社区基础设施找到可持续的资金来源。本文首先总结了佛蒙特州作为医疗改革实验室的经验,然后提出了一个基于社区的人口健康策略的概念模型,该模型使用平衡的投资组合和多样化的资金方法。文章接着回顾了佛蒙特州的人口健康计划,包括平衡投资组合的一个例子以及从该州经验中吸取的教训。