Wedge J H
Department of Surgery, University of Toronto, Ontario, Canada.
Clin Orthop Relat Res. 1994 Nov(308):271-80.
Health care reform is not unique to the United States but reflects fundamental changes in attitudes to health care worldwide. Orthopaedic surgery must examine its role in the context of the overall health care delivery system, rather than in the narrow focus of our specialty, if we are to grow and continue to improve in the future. This lecture describes the evolution of the Canadian Health Care system and draws parallels to the current American environment from which valuable lessons may be learned. There are 5 reasons why health care costs more in the United States than in all other countries which are independent of the fact that the United States has the highest quality of medical care available in the world. These are excessive administrative costs and manpower; oversupply (and hence underutilization) of expensive technology and services; the "medicalization" of social costs; and the tremendous cost of medical liability and malpractice litigation. There are a number of steps that can be taken to enhance the role of orthopaedic surgery in health care without eliminating choice and impairing innovation, which are the critical elements in a high-quality health care system. The Canadian and American systems will be more similar in the future despite the different paths that we are taking in reform, and I believe we can look to the future with optimism and confidence if appropriate measures are taken to ensure that our contributions are effective and efficient.
医疗保健改革并非美国所独有，而是反映了全球对医疗保健态度的根本转变。如果骨科手术想要在未来发展并持续改进，就必须在整个医疗保健服务体系的背景下审视自身角色，而不是局限于我们这个专业的狭隘视角。本次讲座描述了加拿大医疗保健系统的演变，并将其与当前的美国环境进行对比，从中可以汲取宝贵的经验教训。美国医疗保健成本高于其他所有国家，有五个原因，这与美国拥有世界上最高质量的医疗服务这一事实无关。这些原因包括过高的行政成本和人力；昂贵技术和服务的供应过剩（因而利用不足）；社会成本的“医疗化”；以及医疗责任和医疗事故诉讼的巨大成本。可以采取一些措施来增强骨科手术在医疗保健中的作用，同时又不消除选择和损害创新，而选择和创新是高质量医疗保健系统的关键要素。尽管我们在改革中采取了不同的路径，但加拿大和美国的系统在未来将更加相似，我相信，如果采取适当措施确保我们的贡献既有效又高效，我们就能乐观而自信地展望未来。
