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

1、on medicalcare,but health outcomes in the United States are inferior to those inmostotherdevelopednations.Thisinefficiency? spendingmorewithpoorer results ? stems partly from failure to provide effective accessto medical care to a substantial share of the population.Lack of accessleadstowiderdispari

2、tiesin healthin the UnitedStatesthanareexperiencedby the populationsofother developed nations.The fragmenteddeliverysystem also leads tocostshiftinginsurersattempts to transfercosts to other payers, administrative waste, and an imbalance betweenspending on medical care and spending on population hea

3、lth initiatives.There is general agreement that the US health care system should bemore efficientas well as more equitable.Mostcomprehensive proposalsforreforming the system recognize the need for universal coverage that isindependent of employment status, disability status, or age, althoughsome wou

4、ld continue to rely on employers to collect health insurancepayments.Although universal insurance is important, it is not the onlyurgentissue.A reformedsystem shouldintegratepersonalpreventiveandtherapeutic care with public health and should include population-widehealth initiatives. Coordinating pe

5、rsonal medical care with populationhealthwill requirea more structuredsystem than has everexisted inUnited States.We argue that a reformed health care system not only should provideinsurancecoverage forall butshould also be organizedand fundedto take advantage of new knowledgeaboutmedical andnonmedi

6、caldeterminantshealth.Thishealth trustsystem HTSwould1assess thecost of health insurance equitably, 2 promote efficiency by reducingfragmentationand relyingon competitive markets,3allow coordinationof spendingonpopulationmedicalcare,4accommodateheterogeneous preferences,5 buildon existingAmericanhea

7、lth insurance and provider institutions, informed by internationalexperience.UNDERINVESTMENT IN PUBLIC HEALTHUnderinvestmentin preventivecare and populationhealth persistsUniteddespitethe growingevidence thatsuch investmentshavegreatpotentialimprovehealth.Highratesreturnbeendemonstrated for communit

8、y-level interventions to reduce the high-riskbehaviorsthatpromote chronicdiseases,which accounttwo thirdsall deaths in the United States and a higher percentage of deaths amongthe most disadvantagedgroups.Thesechronicdiseasesare oftenassociatedhigh-risklifestyleconsumptionchoices smoking,drinking,an

9、d poordiet, which may be more effectively averted by policy interventions incommunityearlylifecoursealteredbylaterinterventions within the medical care sector.For example, 2 structuralinterventionsCalifornia levyinga cigarettetax and banningindoorsmoking in public places ? resulted in dramatic decli

10、nes in smoking,followed by declinesin the rateslungcancerand heartdiseasestate.Disadvantagedpopulations,whichbeargreatestburden ofdisease,stand tobenefitmost frompublicand populationinterventions.The currentfinancingstructureand organizationof care inprovidestrongincentivestreatillnessafteritoccursr

11、atherthan to invest in prevention. Health insurance policies also encouragea suboptimalmix ofservices,relyingon expensive,and often redundant,technology,inadequate coveragefor preventivecare.caresystem alsowastes resources throughand excessive administrativ costs.To create a more effective and efficient health care system, theStates shouldcapitalizeon currentreform