美国医疗保障制度现状_问题与改革

:2006207212:(02BGJ007);(01JA790017);:(19652),,,(,200433):,,,,,:;;;:F8401684:A:100424892(2006)0520040207,,,,,[1],()()::,,(Medicare)(Medicaid)::,::()1.(Blues)(BlueCrossandBlueShieldPlans),,045(125)20069CollectedEssaysonFinanceandEconomicsNo.5(General,No.125)Sep.200612.(1)(Medicare)196518,,:65;65;4200,354063065[2]:A,(HospitalInsurance)(219%),B,(MedicalInsurance),200611(PrescriptionDrugCoverage)(2)(Medicaid)19,,,5200[3],:;:,,X2,,,3.4600,651615%[4],,,(),,,,2004,8413%,6811%,2712%[5],,4600,,,,,,,:,,,14ManuelTorreblanca,SimonFriend&WimOosterom,April2003,AninsightintotheUShealthcaresystem,PricewaterhouseCoopers,UK.,,,;,20045918%,,,,,2004119,16%,OECD,6280[6],200319606219,,19701980,1016%1219%(2),GDP,,,GDP,GDP11960-2003()(%)()1960267511143197073171034819802458818106719906960121027381995990213143698200013099131345602003167891513567121970-200319701980199019952000200371014716551841910161219117135187179131119919612415616:(%)NationalCenterforHealthStatistics.Health,UnitedStates,2005.Table119.,,2418%,2003,4516%,,,,2003,,,70175%,,,,2005,3429,2420065,():,,,,,,,,,,[7],:,25%;:17-21%,415%;:25%,,,,,,,,,():,,,,,,,,,,,7080,,,,,,():,,,:,(PPS)(FFS),,(DRG),,,,,197034,(PaulEllwood)(theHealthMaintenancestrategy),:,1973(HealthMaintenanceOrganizationAct),1982,,,,DRG,(HealthMaintenanceOrganization,HMO),,,,(PreferredProviderOrganization,PPO),,,,,,,,,,,,200567701108,,,,,70,90(2),:41%,53%,6%[8](),20,,,,,,,,,,,,,,,,,,500,1300,(NationalHealthSecurityAct),,:1.,,,(HealthAlliance)80%4420065,315719%,;20%;2.,,,,3.,4.,,,,,,199652380,;75,1%,10505.,,,,,,1993922,:,,,;,,,,,,,,,,2003l125[9],1965,,,,:(1);(2),;(3),,,:;250,;,,,54,,:1.,,,,,,2.,,,3.,,4.,,;;;:[1].[M].:,1994.[2].[M],:,2005.[3]DianeRowland,Sc.D.MedicaidatForty.HealthCareFinancingReviewPWinter2005-2006,27(2).[4]NationalCenterforHealthStatistics.Health,UnitedStates,2005.WithChartbookonTrendsintheHealthofAmericans.Figure7.Hyattsville,Maryland:2005..[5]Income,Poverty,andHealthInsuranceCoverageintheUnitedStates:2004,U.S.GovernmentPrintingOffice,Washington,DC,2005.[6]Americapshealth2carecrisis:Healthcare,Americapsheadache,TheEconomist,January28th.2006.Washington,DC.[7]RexfordESanterre,StephenP.Neun,HealthEconomics:Theories,InsightsandIndustryStudies,DrydenPress,2000.[8]NeelamK.Sekhri,ManagedCare:theUSexperience,BulletinoftheWorldHealthOrganization,2000,78(6).[9].[J].,2005,22(2).TheCurrentSituations,ProblemsandReformsoftheAmericanpsHealthCareSystemDINGChun(SchoolofEconomics,FudanUniversity,Shanghai200433,China)Abstract:Theamericanpshealthcaresystemisthemostcomplicatedsystemaroundtheworld.Itiscriticizedforitshighcost,lowreturn,lackofimpartialityandetc.HencetheUSgovernmentandinsuranceorganizationscarriedonseriesofmicro2innovationsandmacro2reforms,suchasmanagedcareandDRG,aimingatextendingcoverageandreducingexpenditure.WecanlearnfromsomeitsexperiencewhichwillbenefitourChineseHealthCareSystemreformprogress.Keywords:TheAmericanpsHealthCareSystem;characteristics;reform;managedcare(:)6420065