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

1、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 :Integrating Public Health and Personal Care in a ReformedUS Health Care System出 处: American Journal of Public Health作 者: Chernichovsky, Dov,Leibowitz, Arleen A Rigotti, Nancy A原文 :Integrating Public Health and Personal Care in a Ref

2、ormed USHealth Care SystemTHE UNITED STATES HAS THE most technologically intensive medicalpracticeintheworld.Italsospends more than any other nationon medicalcare,but health outcomes in the United States are inferior to those inmostotherdevelopednations.Thisinefficiency? spendingmorewithpoorer resul

3、ts ? stems partly from failure to provide effective accessto medical care to a substantial share of the population.Lack of accessleadstowiderdisparitiesin healthin the UnitedStatesthanareexperiencedby the populationsofother developed nations.The fragmenteddeliverysystem also leads tocostshiftinginsu

4、rersattempts to transfercosts to other payers, administrative waste, and an imbalance betweenspending on medical care and spending on population health initiatives.There is general agreement that the US health care system should bemore efficientas well as more equitable.Mostcomprehensive proposalsfo

5、rreforming the system recognize the need for universal coverage that isindependent of employment status, disability status, or age, althoughsome would continue to rely on employers to collect health insurancepayments.Although universal insurance is important, it is not the onlyurgentissue.A reformed

6、system shouldintegratepersonalpreventiveandtherapeutic care with public health and should include population-widehealth initiatives. Coordinating personal medical care with populationhealthwill requirea more structuredsystem than has everexisted intheUnited States.We argue that a reformed health car

7、e system not only should providehealthinsurancecoverage forall butshould also be organizedand fundedto take advantage of new knowledgeaboutmedical andnonmedicaldeterminantsofhealth.Thishealth trustsystem HTSwould1assess thecost of health insurance equitably, 2 promote efficiency by reducingfragmenta

8、tionand relyingon competitive markets,3allow coordinationof spendingonpopulationhealthandpersonalmedicalcare,4accommodateheterogeneous preferences,and5 buildon existingAmericanhealth insurance and provider institutions, informed by internationalexperience.UNDERINVESTMENT IN PUBLIC HEALTHUnderinvestm

9、entin preventivecare and populationhealth persistsintheUnitedStatesdespitethe growingevidence thatsuch investmentshavegreatpotentialtoimprovehealth.Highratesofreturnhavebeendemonstrated for community-level interventions to reduce the high-riskbehaviorsthatpromote chronicdiseases,which accountfortwo

10、thirdsofall deaths in the United States and a higher percentage of deaths amongthe most disadvantagedgroups.Thesechronicdiseasesare oftenassociatedwithhigh-risklifestyleconsumptionchoices smoking,drinking,and poordiet, which may be more effectively averted by policy interventions inthecommunityandea

11、rlyinthelifecoursethanalteredbylaterinterventions within the medical care sector.For example, 2 structuralinterventionsinCalifornia? levyinga cigarettetax and banningindoorsmoking in public places ? resulted in dramatic declines in smoking,followed by declinesin the ratesoflungcancerand heartdisease

12、inthestate.Disadvantagedpopulations,whichbearthegreatestburden ofchronicdisease,stand tobenefitmost frompublicand populationhealthinterventions.The currentfinancingstructureand organizationof care intheUnitedStatesprovidestrongincentivestotreatillnessafteritoccursratherthan to invest in prevention.

13、Health insurance policies also encouragea suboptimalmix ofservices,relyingon expensive,and often redundant,technology,withinadequate coveragefor preventivecare.The fragmentedhealthcarefinancingsystem alsowastes resources throughcostshiftingand excessive administrativ costs.To create a more effective and efficient health care system, theUnitedStates shouldcapitalizeon currenthealthreform