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当今世界,卫生保健体系五花八门。其中,美国体系独树一帜。它既有高度市场化的医疗服务,又有政府的大力参与。它既是自由经济的产物,又是各种法律和政策约束力的结果。近几十年发展起来的“管理式”商业健康保险,已经成为美国卫生保健体系的核心力量。与传统的健康保险不同,这种保险模式除了为受保人的医疗服务提供经济保障外,还通过各种管理措施影响医疗服务的过程和医疗提供者的行为,促进卫生服务的质量、效率和效益。同时,也通过各种方式倡导健康的生活方式,提高防病意识,避免和遏制各种致病危险,降低疾病所造成的经济负担。美国是世界上在健康领域花费最多的国家。一年的卫生总费用几乎占国内生产总值(GDP)的1 6%。管理式保险如何在保障医疗服务质量的同时控制医疗费用?管理式保险如何影响医疗服务提供者和消费者的行为?管理式保险与政府、医疗机构和人员之间是什么样的关系?医疗机构、医生和病人之间又是什么样的关系?看病的钱从什么地方来,花到什么地方去了?《美国卫生保健与健康保险体系探秘》系列通过一位在美国健康保险公司工作的华人的亲身经历,为您回答上述问题,帮您全面了解美国的卫生保健和健康保险体系。它山之石,可以攻玉,希望能对我国的医药卫生体制改革提供有益的借鉴。本期故事为连载之四。
In today’s world, the health care system is diverse. Among them, the U.S. system is unique. It has both highly market-oriented medical services and strong government involvement. It is both a product of a free economy and a result of binding laws and policies. The “managed” commercial health insurance developed in recent decades has become a core force in the US health care system. Different from the traditional health insurance, this kind of insurance mode not only provides economic protection for the insured person’s medical service, but also influences the medical service process and the behavior of the medical provider through various management measures, promotes the quality and efficiency of the health service and benefit. At the same time, we also advocate healthy lifestyles in various ways, raise awareness of disease prevention, avoid and contain all kinds of risks and reduce the economic burden caused by diseases. The United States is the country that spends most on health in the world. The total annual health expenditure accounts for almost 16% of gross domestic product. How does managed insurance control medical expenses while ensuring the quality of medical services? How does managed insurance affect the behavior of providers and consumers? What is the relationship between managed insurance and government, medical institutions and personnel? What is the relationship between the doctor and the patient? Where does the doctor’s money come from and where to spend it? The Quest for the Health Care and Health Insurance System in the United States passed a Chinese who works for a U.S. health insurance company Personal experience, for you to answer the above questions, to help you fully understand the United States health care and health insurance system. It is a mountain of stone, can jade, hoping to provide useful reference for our country’s medical and health system reform. This issue is serialized four.