Is neonatal medicine in the United States out of step?
Is neonatal medicine in the United States out of step?
复制标题
美国的新生儿医学是否跟不上？
DOI：
10.1542/peds.92.4.612
复制
发表时间：
1993
期刊：
影响因子：
8
通讯作者：
W. Silverman
中科院分区：
文献类型：
--
作者：
W. Silverman
以下是一项非正式调查的结果，该调查表明美国新生儿科医生的数量过高：新生儿科医生与活产婴儿的比例可能比其他六个国家的调查高出两到六倍（表）。粗略的估计提出了一些令人不安的问题，这些问题只能通过每个国家的正式调查来回答，其中包括新生儿重症监护的年度费用（占国内生产总值的百分比）和新生儿科医生的报酬。
近年来，大多数关于新生儿重症监护局限性的讨论都集中在伦理问题上。随着世界各地医疗费用的飙升，人们对这项活动的经济限制提出了质疑。例如，与美国相比，世界其他国家是否通过控制新生儿科医生的数量及其报酬，对新生儿重症监护设定了更现实的财务限制？新生儿科医生的相对过剩是因为美国高危新生儿数量过多，还是在我们自由放任的医疗体系中，从业人员的数量是由市场驱动的？这些和其他令人不安的问题可能会被忽视，但它们不会消失。
Here are the results of an informal survey which suggest that the number of neonatologists is disproportionately high in the United States: the ratio of neonatologists to liveborn infants may be two to six times higher than in six other countries examined (Table). The rough estimates raise some disturbing questions that can only be answered by formal surveys in each country which include the annual cost of neonatal intensive care (as percent of gross domestic product) and the compensation of neonatologists.
In recent years, most of the discussion about the limits of neonatal intensive care has been focused on ethical issues. As costs of medical care have soared throughout the world, questions are now raised about the economic limits of this activity. For example, compared with the United States, has the rest of the world set more realistic financial limits on neonatal intensive care by controlling the number of neonatologists and their compensation? Is the relative surfeit of neonatologists explained by a disproportionate number of high-risk neonates in the United States, or is the number of practitioners market-driven in our laissez-faire medical system? These and other unsettling questions may be ignored, but they will not go away.