Breslow L, Somers A R
N Engl J Med. 1977 Mar 17;296(11):601-8. doi: 10.1056/NEJM197703172961104.
Current patterns of health care and its financing need to be improved by the incorporation of cost-effective and health-effective preventive measures. As a stimulus for further development, we propose a Lifetime Health-Monitoring Program that uses clinical and epidemiologic criteria to identify specific health goals and professional services appropriate for 10 different age groups. During infancy, for example, we recommend seven immunizations, tests to detect anemia, hemorrhagic diseases, phenylketonuria and developmental deficiencies, and routine prophylaxis of gonorrheal ophthalmia. In the age group 40 to 59, tests for hypertension, cervical, mammary, and gastrointestinal cancer, and control of obesity and smoking are in order. The cost of such preventive measures. which should not be prohibitive, must be covered by health-insurance programs, whether based on fee-for-service or capitation. The program suggested, by incorporating prevention into day-to-day care, should strengthen the patient-physician relation.
当前的医疗保健模式及其融资方式需要通过纳入具有成本效益和健康效益的预防措施来加以改进。作为进一步发展的激励措施，我们提议实施一项终身健康监测计划，该计划利用临床和流行病学标准来确定适合10个不同年龄组的具体健康目标和专业服务。例如，在婴儿期，我们建议进行七种免疫接种、检测贫血、出血性疾病、苯丙酮尿症和发育缺陷的测试，以及常规预防淋菌性眼炎。在40至59岁年龄组，应进行高血压、宫颈癌、乳腺癌和胃肠道癌的检测，以及控制肥胖和吸烟。这种预防措施的费用不应过高，必须由医疗保险计划承担，无论是基于按服务收费还是按人头收费。所建议的计划通过将预防纳入日常护理，应能加强医患关系。
