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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。这能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16%。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中国人的亲身经历,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,可以政玉。希望能对我国的医药卫生体制改革提供有益的借鉴。本系列将分六期连载。本期故事为连载之二。
In today’s world, health care systems are varied. Among them, the United States system is unique. It has both highly marketized medical services and strong government involvement. It is both the product of a free economy and the result of various legal and policy binding forces. The “managed” commercial health insurance developed in recent decades has become the core strength of the U.S. health care system. Unlike traditional health insurance, this insurance model not only provides financial protection for the insured’s medical services, but also influences the process of medical services and the behavior of medical providers through various management measures. This can promote the quality, efficiency and effectiveness of health services. At the same time, it also advocates healthy lifestyles through various means, raises awareness of disease prevention, avoids and curbs various pathogenic risks, and reduces the economic burden caused by the disease. The United States is the world’s most expensive country in health. The total health expenditure for a year accounts for almost 16% of the gross domestic product (GDP). How does managed insurance control medical expenses while ensuring the quality of medical services? How does managed insurance affect the behavior of medical service providers and consumers? What is the relationship between managed insurance and government, medical institutions and people? What is the relationship between the doctor and the patient? Where does the doctor’s money come from and where does it go? The U.S. Health Care and Health Insurance System Quest series passes through a China health insurance company in China. Your personal experience will answer these questions and help you to fully understand the health care and health insurance system in the United States. It is a rock of the mountain, it can be a political jade. It is hoped that this will provide a useful reference for the reform of China’s medical and health system. This series will be serialized in six phases. This story is serialized two.