政府在美国医疗保障领域的作用探讨
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摘要
美国固有的相互矛盾却又并存的两大观念影响医疗保障服务的可及性。一个传统观念是认为个人应该为自己的福利负责,包括健康;另一个传统观念则认为社区有责任为全民提供健康的可及性,尤其是对那些无法依靠自身取得的人群。目前医疗保障的未来方向很明确,那就是已经确定政府,尤其是联邦政府,应该为全国人民组织协调大型健康保障项目。社会公认为"健康保障不是特权,而是人人应该享有的权利",这也进一步呼吁联邦政府把这一口号落实到现实。20世纪60年代这个口号很有用,但是当试图解决以下问题时却出现了争议:健康保障的度如何把握;保障的近便如何界定;保障的质如何;保障的资金来源和个人自我保护的责任等问题。作者认为,在美国,政府的作用是间接地影响那些现有的机构及人们的行为,比如从事私人营业的医生,非营利私人医院和各种各样非政府保险计划等。在谈及各级政府的介入程度时,联邦政府不应该过多参与具体项目的实施,而应该让州政府和地方政府来具体实施。政府的管理作用方面,作者认为目前的规章制度使得服务提供者对病人的态度不是同情或真实关心,而是持怀疑态度,因此在管理方面的方向应该把这种负面影响转变为正面的有建设性的促因。
引文
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U.S.General Accounting Office.1997.Employment-Based Health Insurance:Cost Increase and Family Decreases.February 1997,GAO/HEHS-97-35.Washington,DC:U.S.Government Printing Office.
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William Shonick.Government and Health Service;Government's Role in the Development of U.S.Health Services,1995,New York Oxford,Oxford University Press.
Bodenheimer,T.and K.Sullivan.1998.How Large Employers Are Shaping the Health Care Marketplace.2 parts.New England Journal of Medicine 338(14);1003—1007,(15):1084—1087.
Carrasquillo,O.,D.Himmelslein,S.Woolhandler,and D.Bor.1999.A Reappraisal of Private Employers'Rote in Providing Health insurance.New England fournal of Medicine 340(2):109—114.
Friedman Milton.Capitalism and Freedom.Chicago;University of Chicago Press,1962.
Haynes Johnson and David S.Broder,The System;The American Way of Politics at the Breaking Point,1996,Boston.
Iglehart,J.1999.The American Heaith Care System;Expenditures.New England Journal of Medicine 340(1):70—76.
Jennie Jacobs Kronenfeld.The Changing Federal Role in U.S.Health Care Policy by,1997,London.
Kuttner.R.1999.The American Health Care System;Health Insurance Coverage.New England Journal of Medicine 340(2):163-168.
Morone,J.A.1990.The Democratic Wish:Popular Participation and the limits of American Government.New York;Basic Books.
Scanlon,W.1997.Health Insurance for Children;Declines in Employment-Based Coverage Leave Millions Uninsured.8 April,GAO/T-HEHS-97-105.Washington,DC;General Accounting Office.
Sloan,F.A.,and C.J.Conover.1999.Effects of State Reforms on Health Insurance Coverage of Adults.Inquiry 35:280-293.
Stern B.J.Medical Services by Government:Local,State and Federal,1946.
TomGallagher.Is big government back"!July 2003,Business Economics,pg.25-37.
Turnock Bernard&Atchison Christopher.Governmental public health in the United States:The implications of federalism,Nov/Dec 2002,Health Affairs,pg.68-78.
U.S.Census Bureau.1999.Health insurance Coverage.1998.September.1998(P60-208).Washington,DC;U.S.Government Printing Office.
U.S.Executive Office of the President.1998.Analytical Perspectives of the United States:Fiscal 1999.Washington.DC:U.S.Government Printing Office.
U.S.General Accounting Office.1997.Employment-Based Health Insurance:Cost Increase and Family Decreases.February 1997,GAO/HEHS-97-35.Washington,DC:U.S.Government Printing Office.
——.1998.Health Insurance Standards:New Federal Law Creates Challenges for Consumers.Insurers;Regulators.25 February,GAO/HEHS-98-67.Washington,DC;U.S.Government Printing Office.
William Shonick.Government and Health Service;Government's Role in the Development of U.S.Health Services,1995,New York Oxford,Oxford University Press.