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加拿大和美国为寻求医疗卫生经费管理的有效方法进行了大规模的社会尝试。虽然两国的社会制度和卫生保健体制十分相似,但却有两种根本不同的经费补偿制。由于加拿大已经避免或解决了一些对美国说来比较难对付的问题,因此美国对加拿大的这种社会尝试颇感兴趣,特别是加拿大将其总的卫生经费保持在国民收入中一个稳定的比例,而且广泛的保险也解决了一些问题,比如,没有经济补偿的医疗服务、重症病人的个人负担以及未参加保险者的医疗费用等。美国某些观察家对加拿大既控制医疗费用又实行广泛的保险感到吃惊。笔者对两国卫生经费的一些数据作了比较,指出他们在做法上的明显不同,并分别描述了两国的经费管理方法。可以看出,不管哪一种管理体制总是存在着经费提供者与消费者之间的矛盾。行政过程集中了这一矛盾,而市场过程则起了扩散作用。但是加拿大各派系间在政策上的论战对个体医生专业自主性的影响要比美国小。
Canada and the United States have made large-scale social attempts to find effective ways to manage health care funds. Although the social systems and health care systems in the two countries are very similar, there are two fundamentally different compensation systems. Since Canada has already avoided or solved some of the problems that the United States has said is more difficult to deal with, the United States is very interested in this social attempt by Canada. In particular, Canada has kept its total health expenditure in a stable proportion of national income. And extensive insurance has also solved some problems, such as medical services without financial compensation, personal burden of critically ill patients, and medical expenses of those who have not participated in insurance. Some observers in the United States were surprised at Canada’s control of medical expenses and widespread insurance. The author compares some of the data on health expenditures between the two countries and points out that they are clearly different in their practices. They also describe the methods of fund management in both countries. It can be seen that no matter what kind of management system is always there is a contradiction between the providers of funds and consumers. The administrative process has concentrated this contradiction, and the market process has played a diffusion role. However, the policy debate among Canadian factions has less influence on the autonomy of individual doctors than in the United States.