Diabetes And The Fragmented State Of US Health Care And Policy.

Diabetes And The Fragmented State Of US Health Care And Policy.
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糖尿病与美国医疗保健和政策的支离破碎状态。

DOI:
10.1377/hlthaff.2022.00299
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发表时间:
2022-07
期刊:
影响因子:
9.7
通讯作者:
All, Mohammed K.
All, Mohammed K.
中科院分区:
医学1区
文献类型:
--
作者:
Chehal, Puneet Kaur;Selvin, Elizabeth;DeVoe, Jennifer E.;Mangione, Carol M.;All, Mohammed K.

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在过去的十年中,美国预防和治疗2型糖尿病(糖尿病的主要形式)的进展似乎已经停滞,糖尿病相关的发病率在全国范围内增加。人口中地理和社会经济条件最不利的部分受到的打击尤其严重,而降低糖尿病风险的干预措施尚未惠及这些人群。在这篇综述文章中,我们阐述了美国卫生政策和治理、支付者和报销设计以及服务提供方面的碎片化是如何导致问责制和协调性低下,从而导致停滞和持续不平等的。我们还回顾了有关过去,正在进行的和新的改革,可能有助于解决碎片化,降低糖尿病负担和缩小差距的证据。
Progress in the prevention and treatment of type 2 diabetes—the dominant form of diabetes—appears to have stalled in the US over the past decade, and diabetes-related morbidity has increased nationally. The most geographically and socioeconomically disadvantaged segments of the population have been especially hard hit, and interventions that reduce the risk for diabetes have not reached these populations. In this overview article we lay out how fragmentation in health policy and governance, payers and reimbursement design, and service delivery in the US has contributed to low accountability and coordination, and thus stagnation and persistent inequities. We also review the evidence regarding past, ongoing, and new reforms that may help address fragmentation, lower diabetes burdens, and narrow disparities.
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