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.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.docx

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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

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

本科毕业论文外文翻译

外文题目:

IntegratingPublicHealthandPersonalCareinaReformed

USHealthCareSystem

出处:

AmericanJournalofPublicHealth

作者:

Chernichovsky,Dov,Leibowitz,ArleenARigotti,NancyA

原文:

IntegratingPublicHealthandPersonalCareinaReformedUS

HealthCareSystem

THEUNITEDSTATESHASTHEmosttechnologicallyintensivemedical

practice

in

the

world.It

also

spendsmorethananyothernation

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

the

UnitedStates.

Wearguethatareformedhealthcaresystemnotonlyshouldprovide

health

insurance

coveragefor

allbut

shouldalsobeorganized

andfunded

totakeadvantageofnewknowledge

about

medicaland

nonmedical

determinants

of

health.

This

healthtrust

systemHTSwould

1

assessthe

costofhealthinsuranceequitably,2promoteefficiencybyreducing

fragmentation

andrelying

oncompetitivemarkets,

3

allowcoordination

ofspending

on

population

health

and

personal

medical

care,

4

accommodateheterogeneouspreferences,

and

5build

onexisting

American

healthinsuranceandproviderinstitutions,informedbyinternational

experience.

UNDERINVESTMENTINPUBLICHEALTH

Underinvestment

inpreventive

careandpopulation

healthpersists

in

the

United

States

despite

thegrowing

evidencethat

suchinvestments

have

great

potential

to

improve

health.High

rates

of

return

have

been

demonstratedforcommunity-levelinterventionstoreducethehigh-risk

behaviors

that

promotechronic

diseases,

whichaccount

for

twothirds

of

alldeathsintheUnitedStatesandahigherpercentageofdeathsamong

themostdisadvantaged

groups.These

chronic

diseases

areoften

associated

with

high-risk

lifestyle

consumption

choicessmoking,

drinking,

andpoor

diet,whichmaybemoreeffectivelyavertedbypolicyinterventionsin

the

community

and

early

in

the

life

course

than

altered

by

later

interventionswithinthemedicalcaresector.Forexample,2structural

interventions

in

California

?

levying

acigarette

taxandbanning

indoor

smokinginpublicplaces?

resultedindramaticdeclinesinsmoking,

followedbydeclines

intherates

of

lung

cancer

andheart

disease

in

the

state.Disadvantaged

populations,

which

bear

the

greatest

burdenof

chronic

disease,

standto

benefit

mostfrom

public

andpopulation

health

interventions.

Thecurrent

financing

structure

andorganization

ofcarein

the

United

States

provide

strong

incentives

to

treat

illness

after

it

occurs

rather

thantoinvestinprevention.Healthinsurancepoliciesalsoencourage

asuboptimal

mixof

services,

relying

onexpensive,

andoftenredundant,

technology,

with

inadequatecoverage

forpreventive

care.

Thefragmented

health

care

financing

systemalso

wastesresourcesthrough

cost

shifting

andexcessiveadministrativcosts.

Tocreateamoreeffectiveandefficienthealthcaresystem,the

United

Statesshould

capitalize

oncurrent

health

reform