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奥巴马总统的论文论述了什么? 精选

已有 6742 次阅读 2016-7-14 17:31 |个人分类:医疗纵横|系统分类:科研笔记| 论文

奥巴马总统的论文论述了什么

周 健

【写在前面】奥巴马总统在美国医学会杂志上发表论文,引起了人们的关注。为了介绍奥巴马总统先生的论文,特此将其论文摘要译出,仅供参考。限于译者学识与经验的限制,译文难免错漏,欢迎指正。英文原文附后。

美国医疗改革取得的进展及其未来

重要性: 美国在1965年就设计和颁布了医疗保险和医疗补助方面的一个重要法律制度:平价医疗法。对该法案的综合改革的宗旨是提高医疗保健的可及性、可承受性和医疗保健质量。

目的:分析到目前为止的、影响卫生改革决策的各种因素和该法案实施效果的总体证据,总结评价有关平价医疗法案在公共卫生政策层面的经验教训,推进医疗保健系统的质量改善。

证据:所有数据来自1963年到2016年初期间,涵盖了政府机构、研究机构的研究成果和其它可获得的公共数据资料。

发现:在应对美国医疗保健系统长期以来所面对的,在可及性、可承受性和医疗保健质量的巨大挑战方面,平价医疗法案取得了重大的进展。从该法案实施以来,美国人的未参保率从43%下降到2010年16%、2015年的9.1%,这主要得益于该法案的改革。研究结果表明,随之而来的改善包括:在可及性(例如,估计未到老年的成年人无法负担医疗费用的人数下降5.5个百分点)、经济保障(例如,估计医疗保险覆盖范围内的个人降低医疗债务600-1000美元)、健康水准(例如,估计未到老年的成年人报告健康水平持平或降低的人数下降3.4个百分点)几个方面。该法案也已经开展了在医疗保健支付系统的改革,估计原有联邦医疗模式中的30%参与了改革,他们选择了捆绑医疗或负责任医疗机构的替代模型进行医疗支付。这些改革已经在参保人逐步减少医药费用支出和提升医疗保健质量方面,显示出持续的效果。尽管获得了这样的进展,但是国家的医疗保健体系改革仍然需要继续。

结论:政策制定者应该依据平价医疗法案所取得的经验,继续推进医疗保险市场和运行系统的改革,增加联邦财政对医疗保险参保人的经费支持,引导身处个体市场竞争不足地域的公众合理规划医疗保险,采取行动降低处方药物的价格。虽然政党各有立场,反对党依旧存在,但是平价医疗法案改革的成功示范,足以说明积极的变革在应对一些国家层面的复杂挑战是能够取得成效的。


United States Health Care Reform

Progress to Date and Next Steps


BarackObama,JD


IMPORTANCE The Affordable Care Act is themost important health care legislation enacted in

the United States since the creation ofMedicare and Medicaid in 1965. The law implemented

comprehensive reforms designed to improvethe accessibility, affordability, and quality of

health care.

OBJECTIVES To review the factorsinfluencing the decision to pursue health reform

summarize evidence on the effects of thelaw to date, recommend actions that could

improve the health care system, andidentify general lessons for public policy

from the Affordable Care Act.

EVIDENCE Analysis of publicly availabledata, data obtained from government agencies

and published research findings. The periodexamined extends from 1963 to early 2016

FINDINGS The Affordable Care Act has madesignificant progress toward solving

long-standing challenges facing the UShealth care system related to access, affordability,

and quality of care. Since the AffordableCare Act became law, the uninsured rate has

declined by 43%, from 16.0% in 2010 to 9.1%in 2015, primarily because of the law's reforms.

Research has documented accompanyingimprovements in access to care (for example, an

estimated reduction in the share ofnonelderly adults unable to afford care of 5.5 percentage

points), financial security (for example,an estimated reduction in debts sent to collection of

$600-$1000 per person gaining Medicaidcoverage), and health (for example, an estimated

reduction in the share of nonelderly adultsreporting fair or poor health of 3.4 percentage

points). The law has also begun the processof transforming health care payment systems

with an estimated 30% of traditionalMedicare payments now flowing through alternative

payment models like bundled payments oraccountable care organizations. These and related

reforms have contributed to a sustainedperiod of slow growth in per-enrollee health care

spending and improvements in health carequality. Despite this progress, major opportunities

to improve the health care system remain.

CONCLUSIONS AND RELEVANCE Policy makersshould build on progress made by the

Affordable Care Act by continuing toimplement the Health Insurance Marketplaces

and delivery system reform, increasingfederal financial assistance for Marketplace enrollees

introducing a public plan option in areaslacking individual market competition, and taking

actions to reduce prescription drug costs.Although partisanship and special interest

opposition remain, experience with theAffordable Care Act demonstrates that positive

change is achievable on some of thenation's most complex challenges.


0一六年七月十四日

Contactj6789@163.com

原文:doi:10.1001/jama.2016.9797




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