Weiner J
Johns Hopkins University, School of Hygiene and Public Health, Baltimore.
Scand J Prim Health Care. 1988 Feb;6(1):13-27. doi: 10.3109/02813438809009285.
In the United States large corporately owned health care delivery institutions, some of which are known as health maintenance organizations (HMOs), are assuming an increased prominence in the provision of primary care (PC). These private organizations are similar in many ways to the public-sector providers that have functioned for decades within the Scandinavian systems. This article explores the similarities and differences between these two PC approaches. This is accomplished by contrasting the governance, organization, financing and staffing of the PC systems of three Nordic countries (Denmark, Finland, and Sweden) to that of the US. Also provided is a critical analysis of the extent to which each model attains the ideal attributes of PC including; 1) accessibility, 2) comprehensiveness, 3) coordination and continuity, and 4) sensitivity to the patient's social milieu. For each facet of PC assessed, the American models offer approaches that are worthy of consideration by Scandinavian clinicians and planners. These include innovations in the areas of coordination between primary and secondary care, preventive care for adults and incentives for financial efficiency. Also, although successful in attaining many attributes of PC, this article discusses some perceived weaknesses of the Scandinavian systems.
在美国，大型企业所有的医疗保健服务机构，其中一些被称为健康维护组织（HMOs），在提供初级保健（PC）方面正日益突出。这些私人组织在许多方面与在斯堪的纳维亚体系内运作了数十年的公共部门提供者相似。本文探讨了这两种初级保健方法的异同。这是通过对比三个北欧国家（丹麦、芬兰和瑞典）的初级保健系统与美国初级保健系统的治理、组织、融资和人员配置来实现的。此外，还对每种模式在多大程度上具备初级保健的理想属性进行了批判性分析，这些属性包括：1）可及性，2）全面性，3）协调性和连续性，4）对患者社会环境的敏感性。对于所评估的初级保健的每个方面，美国模式提供了一些值得斯堪的纳维亚临床医生和规划者考虑的方法。这些方法包括初级和二级保健之间协调领域的创新、成人预防保健以及提高财务效率的激励措施。此外，尽管斯堪的纳维亚体系在实现初级保健的许多属性方面取得了成功，但本文也讨论了其一些被认为存在的弱点。
