Zucker J L
Am J Law Med. 1980 Spring;6(1):83-103.
Catastrophic health insurance may be necessary to curb rising health care costs in the United States. A major factor in this rise has been the current structure of the nation's health insurance system, which inadequately protects individuals with expensive illnesses, but encourages over-insurance for less expensive illnesses. This Note examines the current health insurance system, and analyzes its impact on health care costs for individuals and society. It evaluates several proposals to modify the structure of the current health insurance system, and recommends the adoption of a catastrophic health insurance plan based on an economic definition of catastrophe. Such a plan would decrease shallow coverage, and would use coinsurance and deductible rates keyed to the individual's income as means of increasing consumer cost consciousness without making necessary care unreasonably expensive. This Note also recommends that a catastrophic plan only cover treatment that has been determined medically necessary by utilization review, and that this review encourage outpatient rather than costly inpatient treatment.
灾难医疗保险对于抑制美国不断上涨的医疗成本或许是必要的。成本上涨的一个主要因素是美国当前的医疗保险体系结构，该结构对患有高额费用疾病的个人保护不足，却鼓励对费用较低疾病的过度保险。本注释审视了当前的医疗保险体系，并分析了其对个人和社会医疗成本的影响。它评估了几项修改当前医疗保险体系结构的提议，并建议采用基于灾难的经济定义的灾难医疗保险计划。这样一个计划将减少浅层保险范围，并将根据个人收入设定的共保率和免赔额作为提高消费者成本意识的手段，同时又不会使必要的医疗费用变得过高。本注释还建议，灾难计划仅涵盖经利用审查确定为医疗必需的治疗，并且该审查应鼓励门诊治疗而非昂贵的住院治疗。
