America's Hidden Health Care State

美国隐藏的医疗保健州

• 批准号: 9230748
• 负责人: COLLEEN M. GROGAN
• 金额: $ 4.84万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9230748
• 关键词: Accountability; Address; Advocate; American; Americas; Area; Books; Capital; Caring; Clinics and Hospitals; Data; Data Sources; Democracy; Development; Economics; Floor; Foundations; Funding; Government; Grant; Health; Health Care Reform; Health Expenditures; Health Personnel; Healthcare; Healthcare Systems; Hearing; Hospitals; Illusions; Insurance; Investments; Liberalism; Marshal; Methods; Ownership; Plant Roots; Policies; Politics; Privatization; Public Health; Publishing; Reporting; Research Infrastructure; Role; Services; Source; Stream; Tax Exemption; Text; Time; TimeLine; United States Public Health Service; prevention service; social

Project Summary/Abstract: America's Hidden Health Care State presents a simple argument with enormous implications. It addresses four important questions: (1) Why is the U.S. health care system repeatedly described as predominately private when public funds have long paid for a higher proportion of national health expenditures than have private insurance funds? (2) Why is hospital ownership repeatedly described as private when the majority of hospitals are not-for-profit and receive substantial government subsides --for over a century-- in the form of tax exemptions, but also –and more importantly—in the form of direct public reimbursement for treatment and public grants for capital investments and development? (3) Why are public health expenditures in the U.S. repeatedly described as a meager 3% of total health expenditures when their reach is (and has been for a long time) much more substantial than this figure suggests? What are the consequences of hiding the true extent of public investment in the US health care system? Although the U.S. health care system is often described as exceptional and rooted in classic American liberal ideology, in reality the state has invested quite substantially in public health prevention services, the building of hospitals and clinics, and in reimbursing health care providers for services rendered. Despite this reality, a unique ideology of American “inverted liberalism” allows the state to invest heavily in the health care system and still call it predominately private. As a result, the role of the state is largely hidden and stakeholders successfully present the illusion of minimal government. The consequences of this illusion are crucially important: because the state's is hidden, the distributional effects are highly unequal, and accountability for such inequities is extremely difficult to locate. The timeline of the book largely covers developments in the 20th century. Chapter one begins by detailing the development of local and state boards of public health just before the turn of the 19th Century and the book concludes by showing the relevance of the argument to understanding what is behind current—and likely ongoing—debates about health care reform and the role of government across the American states.

项目摘要/摘要： 美国的隐藏医疗保健州提出了一个具有巨大影响的简单论点。它解决了四个 重要问题：（1）为什么美国医疗保健系统一再被描述为以私人为主 当公共资金长期以来支付的国家卫生支出比例高于私人资金时 保险资金？ (2) 为什么医院所有权一再被描述为私有，而大多数医院 是非营利性的，并在一个多世纪以来以税收的形式获得大量政府补贴 豁免，而且更重要的是，以直接公共报销治疗和费用的形式 用于资本投资和发展的公共补助金？ （3）为什么美国的公共卫生支出如此之高？ 被反复描述为仅占卫生总支出的微不足道的 3%，而其覆盖范围（并且长期以来一直如此） 时间）比这个数字显示的要大得多？隐藏真实程度会产生什么后果 美国医疗保健系统的公共投资？ 尽管美国的医疗保健系统经常被描述为卓越且植根于经典的美国自由主义 意识形态上，实际上国家在公共卫生预防服务、建设 医院和诊所，以及向医疗保健提供者提供的服务进行补偿。尽管存在这样的现实， 美国“倒置自由主义”的独特意识形态允许国家大力投资医疗保健系统 并且仍然称其主要是私人的。因此，国家的作用在很大程度上是隐藏的，利益相关者 成功地呈现了最小政府的假象。这种错觉的后果至关重要 重要的是：因为国家是隐藏的，所以分配效应是高度不平等的，并且问责制 这种不平等现象极难找到。 这本书的时间线主要涵盖了 20 世纪的发展。第一章首先详细介绍了 十九世纪之交之前地方和州公共卫生委员会的发展以及这本书 最后通过展示该论点与理解当前和可能背后的内容的相关性来得出结论 美国各州关于医疗保健改革和政府角色的争论正在进行中。