在美国的医疗制度改制中整合公共健康和个人护理外文翻译Word文档下载推荐.docx

在美国的医疗制度改制中整合公共健康和个人护理外文翻译Word文档下载推荐.docx

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onmedical

care,buthealthoutcomesintheUnitedStatesareinferiortothosein

most

other

developed

nations.This

inefficiency

?

spending

more

with

poorerresults?

stemspartlyfromfailuretoprovideeffectiveaccess

tomedicalcaretoasubstantialshareofthepopulation.Lackofaccess

leads

to

wider

disparities

inhealth

intheUnited

States

than

are

experienced

bythepopulations

of

otherdevelopednations.

Thefragmented

delivery

systemalsoleadsto

cost

shifting

insurers'

attemptstotransfer

coststootherpayers,administrativewaste,andanimbalancebetween

spendingonmedicalcareandspendingonpopulationhealthinitiatives.

ThereisgeneralagreementthattheUShealthcaresystemshouldbe

moreefficient

aswellasmoreequitable.Most

comprehensiveproposals

for

reformingthesystemrecognizetheneedforuniversalcoveragethatis

independentofemploymentstatus,disabilitystatus,orage,although

somewouldcontinuetorelyonemployerstocollecthealthinsurance

payments.Althoughuniversalinsuranceisimportant,itisnottheonly

urgent

issue.

Areformed

systemshould

integrate

personal

preventive

and

therapeuticcarewithpublichealthandshouldincludepopulation-wide

healthinitiatives.Coordinatingpersonalmedicalcarewithpopulation

health

willrequire

amorestructured

systemthanhasever

existedin

UnitedStates.

Wearguethatareformedhealthcaresystemnotonlyshouldprovide

insurance

coveragefor

allbut

shouldalsobeorganized

andfunded

totakeadvantageofnewknowledge

about

medicaland

nonmedical

determinants

health.

This

healthtrust

systemHTSwould

1

assessthe

costofhealthinsuranceequitably,2promoteefficiencybyreducing

fragmentation

andrelying

oncompetitivemarkets,

3

allowcoordination

ofspending

on

population

medical

care,

4

accommodateheterogeneouspreferences,

5build

onexisting

American

healthinsuranceandproviderinstitutions,informedbyinternational

experience.

UNDERINVESTMENTINPUBLICHEALTH

Underinvestment

inpreventive

careandpopulation

healthpersists

United

despite

thegrowing

evidencethat

suchinvestments

have

great

potential

improve

health.High

rates

return

been

demonstratedforcommunity-levelinterventionstoreducethehigh-risk

behaviors

that

promotechronic

diseases,

whichaccount

twothirds

alldeathsintheUnitedStatesandahigherpercentageofdeathsamong

themostdisadvantaged

groups.These

chronic

diseases

areoften

associated

high-risk

lifestyle

consumption

choicessmoking,

drinking,

andpoor

diet,whichmaybemoreeffectivelyavertedbypolicyinterventionsin

community

early

life

course

altered

by

later

interventionswithinthemedicalcaresector.Forexample,2structural

interventions

California

levying

acigarette

taxandbanning

indoor

smokinginpublicplaces?

resultedindramaticdeclinesinsmoking,

followedbydeclines

intherates

lung

cancer

andheart

disease

state.Disadvantaged

populations,

which

bear

greatest

burdenof

disease,

standto

benefit

mostfrom

public

andpopulation

interventions.

Thecurrent

financing

structure

andorganization

ofcarein

provide

strong

incentives

treat

illness

after

it

occurs

rather

thantoinvestinprevention.Healthinsurancepoliciesalsoencourage

asuboptimal

mixof

services,

relying

onexpensive,

andoftenredundant,

technology,

inadequatecoverage

forpreventive

care.

care

systemalso

wastesresourcesthrough

andexcessiveadministrativcosts.

Tocreateamoreeffectiveandefficienthealthcaresystem,the

Statesshould

capitalize

oncurrent

reform