Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zurich, Switzerland.
Department of Health Systems Management, College of Health Sciences, Rush University, 1700 W. Van Buren St. 126B TOB, Chicago, IL, 60612, USA.
Health Care Anal. 2020 Sep;28(3):228-248. doi: 10.1007/s10728-020-00391-0.
Controversy exists over how to ethically distribute health care resources and which factors should determine access to health care services. Although the US has traditionally used a market-based private insurance model that does not ensure universal coverage, the Patient Protection and Affordable Care Act (ACA) in the United States aims to increase equitable access to health care by increasing the accessibility, affordability, and quality of health care services. This article evaluates the impact of the ACA on equitable mental health care delivery according to access factors that can hinder or facilitate the delivery of mental health services based on need. The ACA has successfully expanded coverage to millions of Americans and promoted coordination and access to mental health care; however, financial and non-financial access barriers to mental health care and access disparities remain. Reform efforts should not undervalue the gains that the ACA has made but should attempt to balance considerations of cost and increasing free-market mechanisms with decreasing remaining health care disparities.
关于如何在伦理上分配医疗资源以及哪些因素应该决定医疗服务的获取，存在争议。尽管美国传统上采用的是基于市场的私人保险模式，无法确保全民覆盖，但美国的《患者保护与平价医疗法案》（ACA）旨在通过提高医疗服务的可及性、可负担性和质量，增加公平获得医疗保健的机会。本文根据可能阻碍或促进基于需求提供精神卫生服务的获取因素，评估 ACA 对公平提供精神卫生保健的影响。ACA 已成功将覆盖范围扩大到数百万美国人，并促进了精神卫生保健的协调和获取；然而，精神卫生保健的经济和非经济获取障碍以及获取方面的差距仍然存在。改革努力不应低估 ACA 取得的成果，而应尝试平衡成本和增加自由市场机制与减少剩余医疗保健差距的考虑因素。
