Personal reflections on the high cost of American medical care: many causes but few politically sustainable solutions.
Personal reflections on the high cost of American medical care: many causes but few politically sustainable solutions.
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对美国医疗费用高昂的个人反思：原因很多，但政治上可持续的解决方案很少。
DOI：
10.1001/archinternmed.2011.149
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发表时间：
2011
影响因子：
--
通讯作者：
S. Schroeder
中科院分区：
文献类型：
--
作者：
S. Schroeder
在医改运动开始时，贝拉克·奥巴马总统承认了一个令人痛苦的事实：要在不让国家破产的情况下扩大医保覆盖范围，就需要改变医保支出曲线。不幸的是，虽然2010年的患者保护和平价医疗法案1大幅扩大了医疗保险，但它可能不会对减缓医疗支出的增长起到什么作用。在遏制过度医疗支出的战斗中，作为一名早期的斗士，我并不奇怪这个国家没有准备好听从总统的信息，也不奇怪政治机会主义者会使用骇人听闻的恐惧策略，比如暗示向人们提供姑息治疗信息等同于建立死亡小组。为了把控制成本的努力放在历史的背景下，我分享我的经历和反思，从我职业生涯的早期开始-1971年-当时医疗保健支出引起了人们的警觉，因为它已经上升到国内生产总值的7.5%，并正走向“不可持续的”10%。(现在已经超过了17%。)在30年的时间里，我首先作为乔治·华盛顿大学(George Washington University)医疗门诊诊所和健康维护组织(HMO)的医学主任，后来在加州大学旧金山分校(UCSF)的卫生政策研究所和普通内科医学部(UCSF)，以及后来作为罗伯特·伍德·约翰逊基金会(RWJF)的主席，观察和研究了导致美国在医疗保健上如此大笔支出的各种因素，以及为什么很难对不断上升的医疗支出曲线进行“弯曲”。
At the start of his campaign for health care reform, President Barack Obama acknowledged a painful truth: to expand coverage without bankrupting the country would require bending the curve of health care expenditures. Unfortunately, while the 2010 Patient Protection and Affordable Care Act 1 makes substantial expansions of health insurance, it will probably do little to slow rising health care expenditures. As an early combatant in the battle to restrain excessive medical care spending—services that bring minimal or no health benefit—I was not surprised that the country is unprepared to heed the president's message, nor that political opportunists would use outrageous fear tactics, such as suggesting that giving people information on palliative care was tantamount to establishing death panels. To place cost containment efforts in historical context, I share my experiences and reflections, beginning early in my career at a time—1971—when the amount spent on medical care caused alarms because it had risen to 7.5% of gross domestic product and was headed for an "unsustainable" 10%. (It is now over 17%.) For a period of 3 decades, first as medical director of the George Washington University (GWU) medical outpatient clinics and health maintenance organization (HMO), later at the Institute for Health Policy Studies and the Division of General Internal Medicine at University of California, San Francisco (UCSF), and subsequently as president of the Robert Wood Johnson Foundation (RWJF), I observed and studied a variety of factors causing why the United States is such a big spender on medical care and why it is so hard to "bend" the curve of escalating medical expenditures.
DOI：
10.1377/hlthaff.2009.0807
发表时间：
2010-09
期刊：
Health affairs (Project Hope)
影响因子：
--
作者：
Mello MM;Chandra A;Gawande AA;Studdert DM
通讯作者：
Studdert DM