Addressing the crisis in US health care: moving beyond denial
Addressing the crisis in US health care: moving beyond denial
复制标题
解决美国医疗保健危机：超越否认
DOI：
10.1136/qhc.12.1.1
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发表时间：
2003
影响因子：
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通讯作者：
D. E. Detmer
中科院分区：
文献类型：
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作者：
D. E. Detmer
医学研究所2002年11月发表的一份新报告为通过美国各州的一系列示范项目提供新的医疗保健系统制定了一个“游戏计划”。我们的目标是看到这些“种子”在未来十年内成长为美国普遍可获得的，安全的，以证据为基础的，以患者为中心的护理，以及具有共同操作标准，安全通信，决策支持和知识管理的国家卫生信息基础设施。
美国医疗体系正处于危机之中，它终于承认了这一现实。与世界其他国家一样，美国的医疗保健面临着越来越多的问题，包括成本上升，获得服务的挑战以及安全和质量的持续广泛差异。在20世纪90年代初第一届克林顿政府通过复杂的“自上而下”方法对美国医疗保健系统进行改革失败以及过去十年的管理式医疗紧缩之后，没有发生任何基本的改革。与此同时，人口又老化了十年，除了个人体重的大幅增加外，还需要更大的综合护理来管理慢性病。诸如健全的信息网络等提高效率的措施几乎没有渗透到初级保健一级。尽管有这些缺点，国家一直缓慢承认，医疗皇帝是裸体除了一些高科技肩章缝在露背检查长袍。
20世纪80年代和90年代初，时任威斯康星州州长的卫生与公众服务部部长汤普森认为，国家的社会福利制度毫无希望，而且过于昂贵，他领导了全国性的改革，通过一个创造性的全州范围的示威游行，然后蔓延到全国。2002年6月中旬，他对美国目前的非医疗保健系统得出了同样的结论。他要求研究所...
A new report published by the Institute of Medicine in November 2002 creates a “game plan” for delivering a new system of health care through a set of demonstration projects in states across the US. The goal is to see these “seeds” grow over the next decade into universally accessible, safe, evidence-based, patient centred care for the US complete with a national health information infrastructure with common operating standards, secure communications, decision support, and knowledge management.
The US healthcare system is in a crisis and it is finally acknowledging this reality. Like other nations around the world, US health care faces mounting problems including rising costs, challenges to access to services, and persistently wide variations in safety and quality. Following the failure of the first Clinton Administration in the early 1990s to reform the US healthcare system through a complex “top down” approach and the managed care belt tightening of the past decade, no basic reforms have occurred. Meanwhile the population has aged another decade, causing a much greater need for integrated care to manage chronic illness, in addition to large increases in personal body mass. Efficiency measures such as robust information networks have scarcely penetrated to the level of primary care. Despite these many shortcomings, the nation has been slow to acknowledge that the healthcare Emperor is naked except for some high technology epaulettes sewn onto a backless examining gown.
In the 1980s and early 1990s Secretary of Health and Human Services Thompson, then Governor of Wisconsin, concluded that the nation’s social welfare system was hopeless and too expensive, and he led the national reform through a creative statewide demonstration that then spread across the nation. In mid June 2002 he concluded the same about the current non-system of health care in the USA. He asked the Institute …