美国医疗保障制度—问题与出路探析
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摘要
健康问题与每一个人的生活息息相关,而医疗保障是人类基本需求之一。在西方最发达国家中,美国是唯一一个没有政府资助的全民医疗保障的国家。
为了说明美国医疗保障制度存在的问题和改革的必要性,本文将对该制度进行比较全面的介绍和分析。但重点在于探讨全民医疗保障在美国历次改革中失败的原因,以供今后的改革借鉴、参考。
本课题主要采用文献法,参考美国各医疗组织的报告,专业的期刊文章和国外已发表的专著、论文。
全文分四个部分,共五章:
第一部分(绪论):总结国内外学者对本课题的研究情况,论述本课题的研究意义和目的。
第二部分(第一、二章):第一章从三方面论述美国医疗保障制度的松散性。第二章讨论美国医疗保障制度存在的突出问题。
第三部分(第三章):集中探讨全民医疗保障在美国的命运。本章为美国的医疗保障制度提供了一条出路,即推行全民医疗,并从现实和理论两方面解释了全民医疗的必要性。本章还列举了美国历史上比较有影响力的几次医疗改革或社会活动,并探讨它们失败的原因。
第四部分(总结):首先总结美国推行全民医疗的失败教训,以期为全民医疗的倡导者提供借鉴。然后指出本文在本课题研究上的局限性,并提供几个需要深入研究的方向以供有兴趣的学者进一步研究探讨。
Health is an issue that affects every person directly, and health care is a basic human need. Among the most highly developed nations in the Western world, only the United States has no comprehensive system of universal health insurance. In order to explain the causes and effects of such a situation in America, this thesis will provide a relatively comprehensive description and evaluation of the American health care system, and study the feasibility of universal health insurance in the United States.
This paper is a content analysis of existing literature to evaluate what is known about American health care system. This is done by conducting an extensive review of existing literature, including medical groups' reports, professional journal articles, as well as an analysis of secondary data obtained from studies previously done.
This thesis is divided into four parts, consisting of five chapters:
Part one (including Introduction) provides a brief literature review about universal health insurance in America, and explains the significance and purpose of this thesis.
Part two includes Chapter I and Chapter II. Chapter I explains the fragmentation of American health care system. Chapter II discusses the main problems under this fragmented system.
Part three (including Chapter III) focuses on universal health insurance in America. This chapter explains the necessity for universal health insurance from practical and theoretical aspects. It also lists some typical historical efforts, and analyzes factors leading to their failures.
Part four (including Conclusion) summarizes lessons from previous efforts so that proponents for universal health insurance could make use of them in the current health care reform debate. It also points out the limitations of this thesis and gives suggestions for further researches.
为了说明美国医疗保障制度存在的问题和改革的必要性,本文将对该制度进行比较全面的介绍和分析。但重点在于探讨全民医疗保障在美国历次改革中失败的原因,以供今后的改革借鉴、参考。
本课题主要采用文献法,参考美国各医疗组织的报告,专业的期刊文章和国外已发表的专著、论文。
全文分四个部分,共五章:
第一部分(绪论):总结国内外学者对本课题的研究情况,论述本课题的研究意义和目的。
第二部分(第一、二章):第一章从三方面论述美国医疗保障制度的松散性。第二章讨论美国医疗保障制度存在的突出问题。
第三部分(第三章):集中探讨全民医疗保障在美国的命运。本章为美国的医疗保障制度提供了一条出路,即推行全民医疗,并从现实和理论两方面解释了全民医疗的必要性。本章还列举了美国历史上比较有影响力的几次医疗改革或社会活动,并探讨它们失败的原因。
第四部分(总结):首先总结美国推行全民医疗的失败教训,以期为全民医疗的倡导者提供借鉴。然后指出本文在本课题研究上的局限性,并提供几个需要深入研究的方向以供有兴趣的学者进一步研究探讨。
Health is an issue that affects every person directly, and health care is a basic human need. Among the most highly developed nations in the Western world, only the United States has no comprehensive system of universal health insurance. In order to explain the causes and effects of such a situation in America, this thesis will provide a relatively comprehensive description and evaluation of the American health care system, and study the feasibility of universal health insurance in the United States.
This paper is a content analysis of existing literature to evaluate what is known about American health care system. This is done by conducting an extensive review of existing literature, including medical groups' reports, professional journal articles, as well as an analysis of secondary data obtained from studies previously done.
This thesis is divided into four parts, consisting of five chapters:
Part one (including Introduction) provides a brief literature review about universal health insurance in America, and explains the significance and purpose of this thesis.
Part two includes Chapter I and Chapter II. Chapter I explains the fragmentation of American health care system. Chapter II discusses the main problems under this fragmented system.
Part three (including Chapter III) focuses on universal health insurance in America. This chapter explains the necessity for universal health insurance from practical and theoretical aspects. It also lists some typical historical efforts, and analyzes factors leading to their failures.
Part four (including Conclusion) summarizes lessons from previous efforts so that proponents for universal health insurance could make use of them in the current health care reform debate. It also points out the limitations of this thesis and gives suggestions for further researches.
引文
Akhter,Mohammad N."APHA Policies on Universal Health Insurance:Health for a Few or Health for All?" American Journal of Public Health 93.1(Jan.2003):99-101.
Balotsky,Edward R."Where Strategy and Ethics Converge:Pharmaceutical Industry Pricing Policy for Medicare Part D Beneficiaries." Journal of Business Ethics (March 2008):1-14.
Bayer,Ronald,Daniel Callahan,Arthur L.Caplan and Bruce Jennings."Toward Justice in Health Care." American Journal of Public Health 78.5(May 1988):583-88.
Birn,Anne-Emanuelle,Theodore M.Brown,Elizabeth Fee and Walter J.Lear."Struggles for National Health Reform in the United States." American Journal of Public Health 93.1(Jan.2003):86-91.
Carmalt,Jean and Sarah Zaidi.The Right to Health in the United States of America—What Does it Mean? Brooklyn,N.Y.:Center for Economic and Social Rights,2004.
Chua,Kaoping."Overview of the U.S.Health Care System." AMSA Jack Rutledge Fellow 2005-2006(Feb.2006):1-6.
Cochran,Clark E.,Lawrence C.Mayer,T.R.Carr and N.Joseph Cayer.American Public Policy.5~(th) ed.New York:St.Martin's Press,1996.
Cunningham,Peter J.and Jessica H.May."Insured Americans Drive Surge in Emergency Department Visits." Issue Briefs 70(Oct.2003):1-6.
Davis,Karen."Universal Coverage in the United States:Lessons from Experience of the 20~(th) Century." Journal of Urban Health:Bulletin of the New York Academy of Medicine 78.1(Mar.2001):46-58.
DeFleur,Milvin L.Social Problems in American Society.Boston:Houghton Mifflin Company,1983
DeNavas-Walt,Carmen,Bernadette D.Proctor and Cheryl H.Lee."Income,Poverty,and Health Insurance Coverage in the United States:2004." Current Population Reports(Aug.2005):60-229.
Derickson.Alan.Health Security for All:Dreams of Universal Health Insurance in America.Baltimore:Johns Hopkins University Press,2005.
DeVoe,Jennifer."The Unsustainable US Health Care System:A Blueprint for Change."Annals of Family Medicine 6.3(May/June 2008):263-66.
Duchovny,Noelia and Lyle Nelson.The State Children's Health Insurance Program.Washington,D.C.:U.S.Congressional Budget Office,2007.
Espe,Erik.The Uninsured in America.Mountain View,California:Vimo Research Group,2007.
Fillerup,Selvoy M.Cut Costs or Go Home! Merrick,N.Y.:Center for Health Care Policy Research and Analysis,2007.
Fox,Harriette B.,et al.Racial and Ethnic Disparities in Adolescent Health and Access to Care.Washington,D.C.:The National Alliance to Advance Adolescent Health,2007.
Funigiello,Philip J.Chronic Politics:Health Care Security from FDR to George W.Bush.Lawrence:University of Kansas Press,2006.
Ginsburg,Jack A.,Robert B.Doherty,J.Fred Ralston Jr.and Naomi Senkeeto."Achieving a High-Performance Health Care System with Universal Access:What the United States Can Learn from Other Countries." Annals of Internal Medicine 148.1(Jan.2008):55-75.
Henry J.Kaiser Family Foundation.Health Care Costs:Key Information on Health Care Costs and Their Impact.California:Henry J.Kaiser Family Foundation,2007.
Herz,Elicia J.and Chris L.Peterson.State Children's Health Insurance Program (SCHIP):A Brief Overview.Washington,D.C.:Congressional Research Service,2006.
Jennings,Carole P."The Evolution of U.S.Health Policy and the Impact of Future Trends on Nursing Practice,Research,and Education." Policy,Politics & Nursing Practice 2.3(Aug.2001):218-27.
Kendall,David B.Fixing America's Health Care System:A Progressive Plan to Cover Everyone and Restrain Costs.Washington,D.C.:Progressive Policy Institute,2005.
Lambrew,Jeanne M."A Wellness Trust to Prioritize Disease Prevention." The Hamilton Project(April 2007):1-31.
National Coalition on Health Care.Building a Better Health Care System:Specifications for Reform.Washington,D.C.:National Coalition on Health Care,2004.
Navarro,Vicente."The Politics of Health Care Reforms in U.S.Presidential Elections."International Journal of Health Services 38.4(2008):597-606.
Oberlander,Jonathan."The US Health Care System:On a Road to Nowhere?"Canadian Medical Association Journal 167.2(July 2002):163-68.
Reinhardt,Uwe E."Is There Hope for the Uninsured?" Health Affairs 3(Aug.2003):376-90.
Reinhardt,Uwe E.,Peter S.Hussey and Gerard F.Anderson."U.S.Health Care Spending in an International Context." Health Affairs 23.3(May/June 2004):10-25.
Relman,Arnold S."The Health of Nations:Medicine and the Free Market." The New Republic,232.8(March 2005):23-29.
Rubiner,Laurie and Cindy Zeldin.America's Fragmented Health Care System:The Spiraling Costs We See and the Hidden Costs We Don't.Washington,D.C.:New America Foundation,2004.
Skocpol,Theda.Social Policy in the United States:Future Possibilities in Historical Perspective.Princeton,N.J.:Princeton University Press,1995.
Sridhar,Devi.Inequality in the United States Healthcare System.New York:Human Development Report Office,2005.
Starr,Paul."Health Care's Big Choice." American Prospect 15.10(Oct.2004):30-33.
Tuohy,Carolyn H.,Colleen M.Flood and Mark Stabile."How Does Private Finance Affect Public Health Care Systems? Marshaling the Evidence from OECD Nations." Journal of Health Politics,Policy & Law 29(2004):359-96.
Vera,Amber L.Analysis of the United States and Canadian Health Care Systems.Diss.California State University,2006.
Vladeck,Bruce."Universal Health Insurance in the United States:Reflections on the Past,the Present,and the Future." American Journal of Public Health 93.1(2003):16-19.
Balotsky,Edward R."Where Strategy and Ethics Converge:Pharmaceutical Industry Pricing Policy for Medicare Part D Beneficiaries." Journal of Business Ethics (March 2008):1-14.
Bayer,Ronald,Daniel Callahan,Arthur L.Caplan and Bruce Jennings."Toward Justice in Health Care." American Journal of Public Health 78.5(May 1988):583-88.
Birn,Anne-Emanuelle,Theodore M.Brown,Elizabeth Fee and Walter J.Lear."Struggles for National Health Reform in the United States." American Journal of Public Health 93.1(Jan.2003):86-91.
Carmalt,Jean and Sarah Zaidi.The Right to Health in the United States of America—What Does it Mean? Brooklyn,N.Y.:Center for Economic and Social Rights,2004.
Chua,Kaoping."Overview of the U.S.Health Care System." AMSA Jack Rutledge Fellow 2005-2006(Feb.2006):1-6.
Cochran,Clark E.,Lawrence C.Mayer,T.R.Carr and N.Joseph Cayer.American Public Policy.5~(th) ed.New York:St.Martin's Press,1996.
Cunningham,Peter J.and Jessica H.May."Insured Americans Drive Surge in Emergency Department Visits." Issue Briefs 70(Oct.2003):1-6.
Davis,Karen."Universal Coverage in the United States:Lessons from Experience of the 20~(th) Century." Journal of Urban Health:Bulletin of the New York Academy of Medicine 78.1(Mar.2001):46-58.
DeFleur,Milvin L.Social Problems in American Society.Boston:Houghton Mifflin Company,1983
DeNavas-Walt,Carmen,Bernadette D.Proctor and Cheryl H.Lee."Income,Poverty,and Health Insurance Coverage in the United States:2004." Current Population Reports(Aug.2005):60-229.
Derickson.Alan.Health Security for All:Dreams of Universal Health Insurance in America.Baltimore:Johns Hopkins University Press,2005.
DeVoe,Jennifer."The Unsustainable US Health Care System:A Blueprint for Change."Annals of Family Medicine 6.3(May/June 2008):263-66.
Duchovny,Noelia and Lyle Nelson.The State Children's Health Insurance Program.Washington,D.C.:U.S.Congressional Budget Office,2007.
Espe,Erik.The Uninsured in America.Mountain View,California:Vimo Research Group,2007.
Fillerup,Selvoy M.Cut Costs or Go Home! Merrick,N.Y.:Center for Health Care Policy Research and Analysis,2007.
Fox,Harriette B.,et al.Racial and Ethnic Disparities in Adolescent Health and Access to Care.Washington,D.C.:The National Alliance to Advance Adolescent Health,2007.
Funigiello,Philip J.Chronic Politics:Health Care Security from FDR to George W.Bush.Lawrence:University of Kansas Press,2006.
Ginsburg,Jack A.,Robert B.Doherty,J.Fred Ralston Jr.and Naomi Senkeeto."Achieving a High-Performance Health Care System with Universal Access:What the United States Can Learn from Other Countries." Annals of Internal Medicine 148.1(Jan.2008):55-75.
Henry J.Kaiser Family Foundation.Health Care Costs:Key Information on Health Care Costs and Their Impact.California:Henry J.Kaiser Family Foundation,2007.
Herz,Elicia J.and Chris L.Peterson.State Children's Health Insurance Program (SCHIP):A Brief Overview.Washington,D.C.:Congressional Research Service,2006.
Jennings,Carole P."The Evolution of U.S.Health Policy and the Impact of Future Trends on Nursing Practice,Research,and Education." Policy,Politics & Nursing Practice 2.3(Aug.2001):218-27.
Kendall,David B.Fixing America's Health Care System:A Progressive Plan to Cover Everyone and Restrain Costs.Washington,D.C.:Progressive Policy Institute,2005.
Lambrew,Jeanne M."A Wellness Trust to Prioritize Disease Prevention." The Hamilton Project(April 2007):1-31.
National Coalition on Health Care.Building a Better Health Care System:Specifications for Reform.Washington,D.C.:National Coalition on Health Care,2004.
Navarro,Vicente."The Politics of Health Care Reforms in U.S.Presidential Elections."International Journal of Health Services 38.4(2008):597-606.
Oberlander,Jonathan."The US Health Care System:On a Road to Nowhere?"Canadian Medical Association Journal 167.2(July 2002):163-68.
Reinhardt,Uwe E."Is There Hope for the Uninsured?" Health Affairs 3(Aug.2003):376-90.
Reinhardt,Uwe E.,Peter S.Hussey and Gerard F.Anderson."U.S.Health Care Spending in an International Context." Health Affairs 23.3(May/June 2004):10-25.
Relman,Arnold S."The Health of Nations:Medicine and the Free Market." The New Republic,232.8(March 2005):23-29.
Rubiner,Laurie and Cindy Zeldin.America's Fragmented Health Care System:The Spiraling Costs We See and the Hidden Costs We Don't.Washington,D.C.:New America Foundation,2004.
Skocpol,Theda.Social Policy in the United States:Future Possibilities in Historical Perspective.Princeton,N.J.:Princeton University Press,1995.
Sridhar,Devi.Inequality in the United States Healthcare System.New York:Human Development Report Office,2005.
Starr,Paul."Health Care's Big Choice." American Prospect 15.10(Oct.2004):30-33.
Tuohy,Carolyn H.,Colleen M.Flood and Mark Stabile."How Does Private Finance Affect Public Health Care Systems? Marshaling the Evidence from OECD Nations." Journal of Health Politics,Policy & Law 29(2004):359-96.
Vera,Amber L.Analysis of the United States and Canadian Health Care Systems.Diss.California State University,2006.
Vladeck,Bruce."Universal Health Insurance in the United States:Reflections on the Past,the Present,and the Future." American Journal of Public Health 93.1(2003):16-19.