Plaut T F, Arons B S
Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland 20857.
Hosp Community Psychiatry. 1994 Sep;45(9):871-6. doi: 10.1176/ps.45.9.871.
Shortly after his election in 1992, President Clinton appointed a health care reform task force to develop a proposal for providing health care benefits for all American citizens and legal residents. Between February and May 1993 the Interdepartmental Working Group, composed of more than 30 working groups addressing specific health care issues, prepared options for the task force. The Health Security Act was introduced in November 1993. Besides universal coverage and a basic benefit package, provisions included health insurance reform, regional alliances for structuring competition among health insurance plans, consumer choice of health plans, and provisions for Medicaid beneficiaries. Proposed mental health and substance abuse provisions included coverage of intensive nonresidential services, medical management, evaluation and assessment services, and case management. Initial limitations on coverage of inpatient mental health services and psychotherapy would be removed by 2001. The Clinton plan also called for integration of public mental health and substance abuse services into the full range of health services offered by local health plans. Major issues that will have to be resolved if health care legislation is to be enacted include whether regional alliances should be mandatory and whether employers should be required to contribute to insurance premiums.
1992年当选总统后不久，克林顿总统任命了一个医疗保健改革特别工作组，以制定一项为所有美国公民和合法居民提供医疗保健福利的提案。1993年2月至5月间，由30多个处理特定医疗保健问题的工作组组成的跨部门工作组为特别工作组准备了备选方案。1993年11月提出了《健康保障法案》。除了全民覆盖和基本福利套餐外，条款还包括医疗保险改革、构建医疗保险计划竞争的区域联盟、消费者对健康计划的选择以及针对医疗补助受益人的条款。拟议的精神健康和药物滥用条款包括强化非住院服务、医疗管理、评估和评价服务以及病例管理的覆盖范围。到2001年，将取消对住院精神健康服务和心理治疗覆盖范围的初步限制。克林顿计划还要求将公共精神健康和药物滥用服务纳入地方健康计划提供的全方位健康服务中。如果要颁布医疗保健立法，必须解决的主要问题包括区域联盟是否应具有强制性，以及雇主是否应被要求缴纳保险费。
