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 ARigotti, Nancy A.原 文：Integrating Public Health and Personal Care in a Reformed US Health Care System

2、THE UNITED STATES HAS THE most technologically intensive medical practice in the world.It also spends more than any other nation on medical care,but health outcomes in the United States are inferior to those in most other developed nations.This inefficiency spending more with poorer results stems pa

3、rtly from failure to provide effective access to medical care to a substantial share of the population.Lack of access leads to wider disparities in health in the United States than are experienced by the populations of other developed nations. The fragmented delivery system also leads to cost shifti

4、ng (insurers attempts to transfer costs to other payers), administrative waste, and an imbalance between spending on medical care and spending on population health initiatives.There is general agreement that the US health care system should be more efficient as well as more equitable.Most comprehens

5、ive proposals for reforming the system recognize the need for universal coverage that is independent of employment status, disability status, or age, although some would continue to rely on employers to collect health insurance payments.Although universal insurance is important, it is not the only u

6、rgent issue. A reformed system should integrate personal preventive and therapeutic care with public health and should include population-wide health initiatives. Coordinating personal medical care with population health will require a more structured system than has ever existed in the United State

7、s.We argue that a reformed health care system not only should provide health insurance coverage for all but should also be organized and funded to take advantage of new knowledge about medical and nonmedical determinants of health. This health trust system (HTS) would ( 1) assess the cost of health

8、insurance equitably, ( 2) promote efficiency by reducing fragmentation and relying on competitive markets, ( 3) allow coordination of spending on population health and personal medical care, ( 4) accommodate heterogeneous preferences, and ( 5) build on existing American health insurance and provider

9、 institutions, informed by international experience.UNDERINVESTMENT IN PUBLIC HEALTH Underinvestment in preventive care and population health persists in the United States despite the growing evidence that such investments have great potential to improve health.High rates of return have been demonst

10、ratedfor community-level interventions to reduce the high-risk behaviors that promote chronic diseases, which account for two thirds of all deaths in the United States and a higher percentage of deaths among the most disadvantaged groups.These chronic diseases are often associated with high-risk lif

11、estyle consumption choices (smoking, drinking, and poor diet), which may be more effectively averted by policy interventions in the community and early in the life course than altered by later interventions within the medical care sector.For example, 2 structural interventions in California levying

12、a cigarette tax and banning indoor smoking in public places resulted in dramatic declines in smoking, followed by declines in the rates of lung cancer and heart disease in the state.Disadvantaged populations, which bear the greatest burden of chronic disease, stand to benefit most from public and po

13、pulation health interventions.The current financing structure and organization of care in the United States provide strong incentives to treat illness after it occurs rather than to invest in prevention. Health insurance policies also encourage a suboptimal mix of services, relying on expensive, and

14、 often redundant, technology, with inadequate coverage for preventive care. The fragmented health care financing system also wastes resources through cost shifting and excessive administrativ costs.To create a more effective and efficient health care system, the United States should capitalize on cu

15、rrent health reform efforts that aim to make access to care universal and contain its costs within an integrated health system. This will require redesigning the system to allocate resources to therapeutic care and to population health in a balance that more closely reflects their abilities to promo

16、te health and thereby increases the health returns generated by health expenditures.ARCHITECTURE OF AN INTEGRATED HEALTH SYSTEM In addition to providing universal access and equitable funding, a reformed health system should strive to ( 1) increase efficiency by formulating coherent policy with appr

17、opriate incentives, information, and supporting infrastructure; ( 2) foster coordination of public, population, and private health care at the local level; ( 3) impose financial discipline, or cost containment; and ( 4) encourage choice for, and responsiveness to, clients.We propose a health system

18、consisting of a national independent body, a national health trust (NHT), which would coordinate regional-or state-based affiliates-regional health trusts (RHTs) and which would form a coherent national structure to ensure orderly and efficient operation.ADVANTAGES AND SAFEGUARDS IN A HEALTH TRUST S

19、YSTEM Most of the political discussion of health care reform in the United States has centered on the crisis in health care costs and the related lack of access to quality medical care. These important issues are, however, part of a larger problem: the current inability of the United States to care

20、for the health for its population efficiently because it lacks a coherent system for financing and providing medical care as well as a mechanism for allocating resources both to medical care for individuals and to public and population health initiatives. Our proposal would create a logical, nested

21、organization that would build on the foundations of the current US health care system.Our proposed structure would have several fundamental advantages. It could ensure that health spending would be targeted to its most productive uses and that decision makers could take a more appropriate long-term

22、perspective on the health of Americans by investing now in prevention and health promotion, while also providing medical care equitably to all Americans. Such a system would reduce billing costs and administrative waste by eliminating medical underwriting, duplicate coverage, and cost shifting. In a

23、ddition, the rebalancing of personal and population health initiatives and the development and dissemination of information on the constituents of cost-effective health care would act to control costs.Universality The proposed HTS promises every American a portable, basic package of core benefits, i

24、ndependent of employment status, which would comprise personal and population services for prevention and treatment. This HTS would mainstream the care of low-income persons currently enrolled in categorical programs for people with particular characteristics, such as Medicaid for the disabled, the

25、State Childrens Insurance Program for children, or Ryan White Care Act programs for treatment of HIV/AIDS. Under an HTS, a voucher would support enrollment of the categorically eligible in any plan offered in their area, thereby expanding their choice of providers. Plans incentives to favor low-risk

26、 applicants would be mitigated by receipt of a risk-adjusted capitation payment that would be independent of the enrollee contribution.Universality does not imply uniform care, either in content or in form. In an HTS, individuals would have a greater choice of providers than is currently available t

27、o most Americans. Although everyone would be guaranteed the same core benefits, individuals could satisfy diverse preferences by supplementing the core benefits with their personal funds, within the same health system, much as FEHBP enrollees currently do. Although this arrangement may raise the spe

28、cter of a 2-tiered system, supplementation has not been a major issue in the FEHBP. Some individuals now have benefits that exceed the core benefits that can be provided universally. Allowing them to supplement the core benefit package and keep their current health insurance if they prefer it may be

29、 necessary for political acceptability.The organization of health coverage in the Netherlands provides a prototype for the type of system we advocate. Dutch residents receive a risk-adjusted voucher for a basic benefit package, purchased from competing insurers. They can supplement the core benefits

30、 through their own resources or funding from their employer. The Netherlands combats risk segmentation by compensating plans with highly developed risk-adjusted capitation payments.Governance An HTS would finance universal coverage through mandated contributions but would rely on private providers t

31、o supply medical care. It would not resemble socialized medicine. The federal government would in fact remain distant from the organization and management of the system, let alone the management and provision of care. However, to ensure that plans assume a fiduciary role on behalf of the public, the

32、 NHT and RHTs would have to carefully monitor that health plans are providing appropriate care and not engaging in risk selection.The basic nature of US health care provision would remain intact, and all Americans enrolled in an insurance plan of any type could continue to receive care in the same m

33、anner they receive it today, although funding sources would change. The proposed plan would rely heavily on private, nongovernmental entities to insure the core benefits as well as to offer supplemental insurance. Specialized government-run programs such as Medicare and Medicaid could remain in place and function as health plans, a