McNamara J J
Department of Surgery, University of Hawaii, Honolulu 96813, USA.
Ann Thorac Surg. 1995 Nov;60(5):1547-9. doi: 10.1016/0003-4975(95)00798-P.
Most of the factors that underlie Hawaii's current healthcare system were in place by 1950. Many of its healthcare features were shaped during the period from the eighth century AD until the revolution in 1893. Early chiefs made care available for the entire population through specially trained kahunas, or priests, who specialized in healing. There was a uniform, seamless healthcare system. The historical legacy, which came through from the early days, fostered the existence and acceptance of group and salaried practice by physicians, acceptance by employers of the responsibility to provide healthcare to workers, capitated payments to providers, focus on outpatient services, and historically short hospital lengths of stay. The success of Hawaii's system is rooted in its past. Whether other states could or should adopt Hawaii's system is conjectural. In Hawaii healthcare reform is not a new paradigm but rather an evolutionary phenomenon.
构成夏威夷当前医疗体系的大部分因素在1950年时就已存在。其许多医疗特色是在公元8世纪至1893年革命期间形成的。早期的酋长通过经过专门训练的卡胡纳（即祭司）为全体民众提供医疗服务，这些卡胡纳专门从事治疗工作。当时存在一个统一、无缝衔接的医疗体系。从早期传承下来的历史遗产促进了医生集体执业和受薪执业的存在与接受，雇主接受为工人提供医疗保健的责任，向医疗服务提供者支付按人头计算的费用，注重门诊服务，以及历来较短的住院时间。夏威夷医疗体系的成功源于其过去。其他州是否能够或应该采用夏威夷的体系还不确定。在夏威夷，医疗改革不是一种新的模式，而是一种渐进的现象。
