US Health care system 美国医疗体制
美国医疗制度基础
美国医疗制度基础1. 医疗保健体系美国医疗保健体系由多个部分组成，包括私人保险、政府计划、非营利组织和直接支付选项。
私人保险通常由雇主提供，而政府计划如Medicare和Medicaid则为老年人和低收入人群提供保障。
2. 医疗服务提供者医疗服务提供者包括医院、诊所、医生、护士和其他医疗专业人员。
美国拥有高度专业化的医疗体系，医疗人员通常需要经过严格的教育和培训。
3. 医疗支付方式支付方式多样，包括按服务付费、按病例付费、按人头付费等。
此外，还有健康维护组织（HMO）和优先提供者组织（PPO）等保险计划，这些计划通过预付费用来控制成本。
4. 医疗法规美国医疗制度受到严格的法规监管，包括《健康保险流通与责任法案》（HIPAA）和《患者保护与平价医疗法案》（ACA）。
这些法规旨在保护患者隐私和提供负担得起的医疗保险。
5. 医疗质量与安全医疗质量与安全是美国医疗制度的关键组成部分。
美国医疗机构通常需要遵守严格的质量标准，并通过认证机构如联合委员会（The Joint Commission）进行认证。
6. 医疗技术与创新美国在医疗技术与创新方面处于世界领先地位，不断推动新药物、医疗设备和治疗方法的研发。
7. 医疗保健成本美国医疗保健成本高昂，是全球医疗支出最高的国家之一。
高昂的成本部分归因于先进的医疗技术和复杂的医疗体系。
8. 医疗保险覆盖尽管美国医疗制度高度发达，但仍有相当一部分人口没有医疗保险覆盖。
政府和私人机构正在努力扩大保险覆盖范围，以减少未保险人口。
9. 医疗改革美国医疗制度不断面临改革的需求，旨在提高效率、降低成本并改善患者结果。
改革措施包括改善医疗服务的可及性、控制医疗费用和提高医疗服务质量。
10. 患者权利美国医疗制度强调患者权利，包括知情同意、隐私权和选择医疗服务提供者的权利。
美国医疗制度是一个复杂且不断发展的体系，旨在提供高质量的医疗服务，同时应对成本控制和保险覆盖等挑战。
美国医疗系统（AmericanMedicalSystem）
美国医疗系统（American Medical System）Medical system in the United States--------------------------------------------------------------------------------There is a course on medical policy that describes the structure and functioning of the American health care system, the interaction between patients and health care providers, and the role that they play in the health care system. The United States does not currently have a national health care system, and only two Medicare and Medicaid are federally managed medical organizations. Although they are part of social welfare, the former belongs to the elderly medical care, the latter to the disabled and low-income families.The medical administration is closely related to the daily lives of the American people, affecting the patterns of medical referral, the extent of physician prescribing, and the chances that patients will receive appropriate care. In the 90s, the American Medical System plunged into a dilemma of medical waste and unequal allocation of medical resources. Some have a complete health care who accept unnecessary medical services; while others have no insurance (1996, more than 40 million Americans without health insurance or medical insurance), is not perfect, they receive the necessary medical services were deprived of their rights. Over the past few years, however, there has been a landmark change in the health care system in the United states. This major reform stems from a new concept, "Managed care"". Managed care has developed new interactions between American patients, insurance companies, and healthcare workers.Traditionally, employers for their employees to pay the medical insurance premium to the insurance company, the insurance company (the insurer) payment for medical service providers (including physicians, hospitals, home - care, nursing, home institutions or pharmacy). Under the system, the doctor decides what kind of treatment, treatment, and who should provide medical care. Medical costs are usually decided unilaterally by providers of medical services, and insurance companies simply pay medical bills. If the cost is too high, the insurance company will increase the premium for the following year (premium). Under the Managed care system, institutions that settle patient health costs will play the role of managing patient care. Employers and insurance companies don't just pay medical bills. They also decide how much medical care they should give to patients, what medical services, and who should provide them with treatment. In other words, employers and insurance companies will determine the way health care providers receive income and how they pay. Therefore, managed care can be said to be a major change in the American Medical system. In the past, medical professionals, especially physicians, decided that the rights of medical behavior were no longer. Doctors and employers, as well as insurance companies, share their decisions. This profoundly changed the doctor's role in the medical system.Payment system for medical careThere are four kinds of payment system in American Medical care:1) out - of - pocket payment,2) individual, private, insurance,3) employment - based group private insurance4) government financingThe first is the simplest payment system - just as consumers buy goods and services directly. However, based on several characteristics, medical care is different from the general consumer behavior. For example, medical care is the basic human needs, and not a luxury; so if the patient is unable to bear the medical expenses, there must be a different from the out - of - Pocket payment system to help patients to pay for medical expenses and medical needs; and expenditure cannot advance estimates and selection; and when patients receive treatment, often lack these treatment knowledge; not to mention the people do not know what time they will be hit by illness or injury.The second is private insurance - in addition to patients and medical staff, the insurance company is on the one hand to collect premiums, on the other hand, pay the patient's medical expenses to the medical institutions.The third is Employment--based group private insurance - the employer pays all or part of the medical premium for the employer. Health insurance provides a mechanism for allocating medical resources to people who really need it, not on their ability to pay medical bills. In other words, the premium fund is redistributed from the healthy person to the patient, whilethe health care system helps the person who cannot pay the medical expenses to share their expenses. However, the positive significance of health care in this respect has sometimes become its fatal injury. The original is to solve the Out - of - Pocket payment system, the patient can not afford the high medical costs will lead to control medical expenses, but the dilemma. Because under this system, patients don't have to pay for their own medical bills themselves, so virtually everyone will increase the number of visits. Together with medical institutions turning to insurance companies, they can easily raise medical costs. Therefore, based on the consideration of business competition, insurance companies have to lower their premiums to attract young, healthy or low-risk groups. By contrast, the elderly and the sick are becoming less and less able to pay high premiums. In order to cope with the new problems, there are fourth kinds of payment systems, namely Tax - financed government health insurance: Medicare and Medicaid. Medicare's services are for the elderly, funded from social security taxes, federal taxes, and premiums paid by beneficiaries. The Medicaid is run by the state government, targeting low-income people, with federal taxes and state taxes.In our impression, the United States is a country with a sound social welfare system, and the medical care system should be no exception. But in 1996, nearly 1/6 of Americans had no medical insurance. The main reason is that in the employment--based system, some employers are reluctant to insure their employees (the reason is rising year by year reduced premium and enterprise scale makes the employer cannot afford); or some people belong to non employees, or is in a state of temporary unemployment. Although these people could notafford the premiums for private health insurance, they failed to meet standards that could benefit from Medicare and Medicaid.As a result of the recent economic downturn, many people have been forced to change jobs, divorce or retire early because they have been forced to retire by lay off,Suspension or even permanent loss of coverage. But even with health insurance, most insurance companies now restrict access to the care they need. The reason is that in order to reduce expenditure, the insurance company does not cover certain treatments or examinations, such as injection prevention and mammograms. They also reject the cover pre-existing disease, and limit the amount of benefit (benefit), or adopt the co payment system.Reimbursement for medical expenses (reimbursements)We mentioned different medical payment systems and the problem of high medical costs. The main reason for this problem stems from the high costs of medical and medical reimbursement (reimbursements) for physicians and hospitals. As a result, new approaches to reimbursement are being developed to stem the growth of medical costs. And these new methods are the main features of managed care. These methods include:Fee-for-service, episode, of, illness, Diem, payment, capitation, salary (or, global, budget). In the form of reimbursement for the first fee-for-service, the medical unit is paid on the basis of individual visits, EKG checks, or treatment procedures. Under the Payment per procedure system,physicians will have more perform examinations and treatment programs in order to obtain more payment. As a result, medical costs are rising and waste of medical resources. The second way is according to the Diagnosis-related group (DRGs) classification, during a disease, regardless of the amount of medical service, medical service is a sum of all payments to hospitals, such as global surgical fees and Hospital DRGs. The unit of payment is not individual treatment or examination, but case or episode. Under this system, physicians will perform more surgery and limit the number of patients postoperative visits. Because they don't get extra payment from the patient's extra visits, the risk of a rise in medical costs is partly transfer. In third Diem payment way, to accept all patients according to the sum of the day hospital service is payment unit is the number of days (i.e. whether the hospital a day for examination and treatment of patients number, it gets payment is a fixed number). The fourth is capitation, the unit is individual. Regardless of the number, degree, or degree of medical treatment each patient receives in one month or year, payment is given to the head. The reimbursement system is very close to managed care.Because you've already mentioned managed care plan, so let's explain its meaning here. Traditionally, physicians and hospitals charge fees based on individual services. In order to control costs, people joined managed care plan to change the way medical units were paid. In the Managed care organization, three main forms are: Fee-for-service, practice, with, utilization, view, preferred, provider, organizations (PPOs),和健康维护组织（HMO）。
美国的卫生保健制度
联邦政府医疗保障计划分两部分 １ 住院保险 属强制性的 享受者不用缴纳保险费 只要符合社会保 障津贴领取资格或某些特定范围人员 均有资格得到 免费住院津贴 ２ 自愿性补充医疗保障计划 个人需 每月自愿地缴纳保险费 自愿性补充医疗保障计划的 资金来源 是通过参加者缴纳保险费和联邦政府的一 般性财政收入拨款建立的基金支持
图１ 美国的管理保健网络组织 对于每一种 管理保健体系 来说 通常都由三 个独立的合法机构组成一个专业化的 管理体制保健网 络 模式 即由保险基金筹集管理者 政府或雇主 卫生计划者组织 卫生部财务署 各州政府的医疗救助 局 雇主与雇员 及 独立开业医生联盟 或服务提
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美国属社会公共性质的医疗保障 归美国联邦卫生 与社会服务部主管 该部在机构设置上主要有４个重要 的下属部门 １ 公共卫生署 其职责是负责一般性公 共卫生服务项目 如儿童的免疫工作 卫生防疫 癌症 及艾滋病的防治等 ２ 社会福利署 负责成年人 失 业者的有关福利 ３ 老年服务署 负责老年人的医疗 及相关福利问题 ４ 卫生财务署 负责医疗保障法律 法规 卫生经费的计划与管理
３ １ 节约成本 美国卫生部财务署在最近一份报告中指出 保健 市场中以扩大管理保健网络为中心的结构性改变 对 限制卫生费用上涨发挥了重要的作用 节约卫生费用 主要反映在雇主购买保险佣金额及个人卫生消费支出 下降 自１９９３年以来保险佣金每年增长不到２％ 在此之 前均为两位数 如加利福尼亚州的ＨＭＯ１９９２ １９９７年 间交纳保险金下降了１３％ 该州人均住院费也低于全国 平均水平的２５％ 左右 １９９５ １９９８ 年卫生服务消费价格指数 ＣＰＩ 年 均增长率最低 仅为 ３．３％ 而 １９８８ １９９２ 年的 ５ 年累计增长 ６７％ １９９３ １９９７ 年的 ５ 年累计增长率 为 ３ １ ％ 减少了一半以上 卫生服务生产价格指数 ＰＰＩ １９９５ １９９８ 年平均增长率也低于 ２％ 个人 卫生消费水平与ＧＤＰ 的比重 由１３．７％ 下降到１３．５％ 个人卫生消费三项支出下降趋势分析结果表明 药品
美国的医疗制度
美国的医疗制度制订医疗制度的目的是保障人们接受医疗的权利，控制医疗费用，提高医疗质量。
医疗制度内分财源确保方式和医疗提供方法。
财源确保方式有税收、公共保险、个人保险和自费，医疗提供方法有公立机构和私营机构。
美国的医疗制度，无论是财源确保方式还是医疗供给方法都是以私营为主。
在美国，无保险者和高额医疗费是重大的社会问题，美国政府试图通过引进管理竞争等改革来激活医疗市场，解决问题。
美国健康保险与医疗保障美国医疗制度没有全民保险制度之类的长远财源。
医疗费是由联邦政府州政府、个人保险和自费来支付。
个人保险，除个人单独购买的保险(占健康保险的13%)外，主要是雇主自发地给雇员及其扶养者提供的群体性健康保险(占健康保险的61%)。
其随意性很大，但对雇员来说是项重要的利益，而且是医疗供给方的重要财源。
国家医疗照顾制度，是以65岁以上老人和残疾人为对象的单一保险种类。
其资金来源很少一部分来自投保人的保险金，绝大部分由联邦政府负担。
然而老年人认为单靠国家医疗照顾制的支付来保障医疗是不够的，有2/3以上享受国家医疗照顾制的人又参加了自费保险。
公共医疗补助制度，是对贫困人的保险计划，覆盖10%的国民，由联邦政府与州政府按合同共同出资。
实际上只有联邦政府规定的贫困者(老人、残疾人、孕妇、供养子女母亲中的穷人)中的40%的人享受到公共医疗补助。
另外，还有退伍军人医疗计划，财源来自税收，由退伍军人局管理。
此外，有l4%左右的无保险者，由于这些人没有能力购买保险和支付高额医疗费，除得了重病外，他们获得量血压、止血等极平常检查的机会都很少，死亡率高。
这成为了美国整个医疗体制上的问题。
高额医疗费及引发的问题美国每年消耗的医疗费在世界上排第一，其金额占世界医疗费的40%，1980年代以来，每年都在以10%以上的速度增长。
企业的医疗保险负担不断加重，目前甚至超过税后的企业利润。
公费医疗费也大幅度超过限额。
医疗费上涨的原因，并不是因为美国医疗普及率高，而是因为每项诊治费非常高。
第七章 美国医疗保健系统与管理保健
美国卫生系统现状： 卫生系统整体绩效第37位；筹资公平性第54 －55位；人均卫生费用第1位； 2008年人均卫生总费用7538美元，卫生总 费用占GDP的16.0%；人均期望寿命78；政 府支出占卫生总支出的46.5％。
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美国医疗体系发展历史
美国医疗保险发展历史 美国医疗保险体系现状 管理保健
USHealthCareSystemandM anagedCare
田磊TianLei
ChinaPharmaceuticalUniversity
2019/4/4
SchoolofInternationalPharmaceuticalBusiness
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医疗保险模式
国家医疗保险——英国 社会医疗保险——德国 商业医疗保险——美国 储蓄医疗保险——新加坡
美国新医改方案
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美国医疗体系发展历史
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美国医疗服务的历史
1850年以前——医疗卫生体系社会化组织程度低，个体开业的简单服务中心
第一阶段 主要健康问题 医疗技术 医疗组织 人们医疗参与 程度
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1850－1900（宗教团体或者慈善机构） 与食品、饮用水、住房和生活条件相关的 传染性疾病（1853新奥尔良黄热病） 基本没有 没有，仅有利用现有资源，出于慈善进行 治病的个体 积极照顾家庭成员，但缺乏实际知识
美国医疗保险发展历史
20世纪以前，医疗卫生体系主要是一些由宗教团体或者慈善 机构建立的对需要帮助的贫民进行的护理，几乎没有有效的对付 疾病的医疗措施。当时的人们并不认为有义务向所有人群提供医 疗服务或者让有需要的人得到医疗服务。因此，在那个时候并没 有人认识到疾病的经济损失以及需要对这种损失进行保险，所以 那时还没有真正意义上的医疗保险产品。 1850年，富兰克林健康保险公司（非致死性损伤保险）； 1860年，旅行者保险公司（与今天的健康险很相似）； 1866年，共有66家保险公司提供健康保险；
美国管理式医疗简介
美国管理式医疗简介前言在美国，人们一直积极地探讨现今的医疗服务与保障制度。
雇主、消费者与政府政策的决策者都在探寻抑制不断增长的医疗费用的办法和扩大享受医疗福利人群的途径。
如果医疗费用不能得到更好的控制，那么向三千五百多万目前没有享受任何医疗保障的美国人提供医疗服务就会变得比较困难。
除了费用与医疗福利普及这两个主要问题以外，很多人还十分关注所提供医疗服务的质量问题等。
虽然人们对于解决以上问题的各种方法有不同的看法，但大多数美国人都认为有必要对现今的医疗服务与保障制度进行改革。
在改革的各种尝试中，管理式医疗的发展尤为突出，并得到越来越多人的关注。
为此，美国信诺保险集团北京代表处特别根据美国医疗保险协会的有关材料编译了《美国管理式医疗简介》，仅供中国读者参考。
一、管理式医疗概论什么是管理式医疗?管理式医疗是一个处于发展中的概念，目前还没有一个公认的标准定义。
在此，我们大致可将管理式医疗定义为：把医疗服务的提供与提供医疗服务所需资金的供给结合起来的一种系统，这种系统的医疗服务对象为加入该系统的成员，并使用以下一种或几种运作手段：●通过与经过挑选的医疗服务提供者达成的协议向系统加入者提供一系列的医疗服务；●制定选择医疗服务提供者的明确标准；●制定正式的计划来进行医疗服务质量的改善与医药使用的审核；●强调要保持加入者的身体健康，以减少对医疗服务的使用；●建立经济上的奖励机制，以鼓励加入者使用与管理式医疗计划有关的医疗服务提供者所提供的服务。
管理式医疗计划的共同特征大多数管理式医疗系统具有以下六个特征：1、严格的医药使用审核；2、对医生医疗行为的监督与分析；3、由门诊主治医生来管理病人；4、引导病人接受高质量、有效率的医疗服务提供者的医疗服务；5、制定服务质量改善计划；6、建立对医生、医院及其他医疗服务提供者的报销制度以使其在经济上对医疗服务的成本和质量负责。
管理式医疗的根本原则是要负责管理病人所需要的各种服务，并将这些服务结合起来。
美国医疗卫生制度
美国医疗卫生制度美国医疗卫生制度前言医疗是一个重大的民生议题。
中国在90年代开始了对医疗制度的改革。
改来改去，几易其稿，始终无法找到一个皆大欢喜的办法。
相反地，似乎社会上对医疗制度改革的不满情绪越来越强烈，从业者也有越来越多的苦水，矛盾非常明显，甚至到了有可能影响社会稳定的程度。
最近国内公布了新一轮医疗改革的政策和措施。
医疗制度是一个庞大的体系，关系到社会的方方面面和很多相关产业行业，不可能一次性颁布几个政策而达到优化状态。
我认为这是一个长期持续性的动态过程，将不断在实践中进行总结，修改，完善。
笔者在美国医疗管理行业从业多年，一直想把美国的医疗管理制度写一下，以便使国内的同仁和其他对医疗制度比较关心的人士有一个对比，参考和借鉴的对象。
最近终于下了决心，开始动笔，希望在以后几个月的时间内能基本写完。
本文将以连载的方式对美国医疗制度的方方面面进行比较详细的描述，并且结合本人实际工作中的体会，以期在对比中引发大家的理性的思考，形成有建设性的想法。
讨论的目的并不是要完全统一所有人的思想，这是不可能的，也没有必要。
讨论的目的是在于互相启发，发现各自想法中的不足，在不断的撞击中达到新的高度。
医疗体制是事关国民健康和社会稳定的大事。
从一个国家的医疗制度的运行可以观照这个国家的宏观管理水平，制度创新能力，社会公平程度，国民生活水准。
希望中国社会各界都能认真严肃，以合作互信的态度，研究各国之长，去其不足，来完善中国的医疗制度。
我写此文的初衷便是在这一过程中略尽我个人的绵薄之力。
主要章节目录一总述二美国医疗财政制度三医疗保险行业和医疗诉讼四医院和其他医疗机构五医生六护士和其他医疗专业人士七医疗教育八医学和医疗研究九医疗监管制度十医疗设备仪器产业十一制药产业十二医疗信息管理系统十三各种医疗行业组织和利益集团十四中医等非主流医疗方法在美国的发展十五美国医疗制度的困境和改革第一章总述美国的医疗体系是一个充满矛盾的庞然巨物。
美国卫生保障体系
The American Health Care System美国卫生保障体系The US is one of the few industrialized countries that do not have a centralized health insurance system.美国是当今世界极少数工业化的国家之一，却缺少一套集中化的卫生保障体系。
Development of a universal health care program in the US may be difficult because taxes are too low to finance it.由于税太低，资金不足，在美国实现医疗保健普及化的目标存在困难。
But the federal government has become more involved in all aspects of health care.联邦政府已经更加深入管理医疗保健各个方面的问题。
Health insurance plans are widely various,卫生保障计划越来越多样化，but most Americans depend on employ-sponsored health insurance.但是大部分美国企业依赖员工式赞助的医疗保险制度。
Health maintenance organization are becoming popular,医疗维护组织愈来愈受到大众青睐的同时，and many companies have carried out their own programs to insure employees.许多企业执行自己的公司计划，以保障员工利益。
The government has provided supplementary health care政府也制定了医疗保健补充条例，for those who do not have access to private health insurance by the establishment of Medicare and Medicaid.专门适用于个别无法享受医疗保险和医疗援助的人群。
第七章美国医疗保健系统与管理保健最新教材
2019/5/18
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医疗开支：最大的决定因素？
PID: no impact
(诱导需求)
Defensive medicine: 1%
（减少不确定性的防御性医疗）
Aging: 7%
（老龄化）
Insurance: 10%
Income: 5 ~ 25%
Technology: > 50%
主要健康 问题
1980至今
慢性疾病（尤其是与工作场所、环境和遗传相 关的心理、行为疾病，如艾滋病、心理疾病等）
医疗技术
医疗组织 人们医疗 参与程度
医学技术（器官移植、基因治疗、核磁共振等） 成为医疗体系的主要驱动力，医疗支出上升
医疗服务机构组织形式变革与效率改进
民众医学知识迅速膨胀，然而面对医疗服务系 统的复杂程度和昂贵的医疗费用感到越来越失 望和无助
有人认识到疾病的经济损失以及需要对这种损失进行保险，所以
那时还没有真正意义上的医疗保险产品。
1850年，富兰克林健康保险公司（非致死性损 伤保险）；
1860年，旅行者保险公司（与今天的健康险很 相似）；
人们医疗参与 民众开始得到一些医学知识和教育，更多
程度
依赖医院和医生完成护理
2019/5/18
9
主要健康问题：特定病例的特殊治疗、诊断技 术、外伤治疗技术
（肺炎病人的血清疗法，发现糖尿病病人的胰岛素疗法……）
医学教育与医学研究：
放射诊断技术……
2019/5/18
ቤተ መጻሕፍቲ ባይዱ
10
第三阶段
二战－1980
主要健康问题 慢性疾病（心脏病、癌症和中风等）
疾病，如艾滋病、抑郁症、自
第七章美国医疗保健系统与管理保健最新
第七章美国医疗保健系统与管理保健最新美国医疗保健系统是世界上最复杂、最昂贵的医疗保健系统之一、与其他发达国家相比，美国的医疗保健系统存在许多独特的特点和挑战。
在这篇文章中，我将介绍美国医疗保健系统的一些最新情况，并探讨与之相关的一些管理保健的问题。
首先，美国的医疗保健系统被认为是分散的、市场化的系统。
它由许多私人和公共的医疗保健提供者组成，包括医院、医生、护士、保险公司和政府机构。
这种分散的系统导致医疗资源的不均衡分配和高昂的医疗费用。
许多人认为，美国的医疗保健系统需要进行重大以解决这些问题。
近年来，许多美国人面临着医疗保健费用上涨的问题。
在过去的几十年里，美国的医疗保健费用不断增加，远远超过了通胀率的增长。
这一情况使得许多人无法负担得起医疗保健，甚至影响了他们的生活质量和健康状况。
为了应对这个问题，一些州和市政府已经开始实施价格限制和医疗服务优先级制度，以控制医疗费用和提供更好的医疗保健服务。
另一个关键问题是医疗保险的普及性。
在美国，有很大一部分人口没有医疗保险，尤其是那些低收入和没有全职工作的人。
这些人通常无法获得必要的医疗保健，或者只能在疾病发展到晚期时才寻求帮助。
为了解决这一问题，奥巴马政府推出了健康保险市场和医疗援助计划，以提供负担得起的医疗保险给没有工作或低收入的人群。
然而，这些政策在实施过程中遇到了很多挑战，包括高额保费和缺乏医疗资源的问题。
管理保健方面也存在着一些挑战。
美国的医疗保健系统以盈利为导向，这意味着许多医疗保健提供者更关注利润而不是患者的需求。
此外，由于医疗保健市场的竞争激烈，医疗机构和医生常常会过度诊断和过度治疗，以获取更多的收入。
这导致了医疗资源的浪费和患者的不必要的医疗风险。
为了解决这些问题，一些专家呼吁建立更有效的管理保健机制，例如提供质量和效益评估以及患者的医疗决策支持。
总的来说，美国医疗保健系统面临着许多挑战和问题，如高昂的医疗费用、医疗资源分配不均和医疗保险的普及性问题。
美国医院健康管理制度
美国医院健康管理制度在美国，医院健康管理制度是由政府监管和医疗机构自身管理相结合的一个系统。
这个制度包括了医院内部的管理体系、医疗服务的质量和安全、医疗成本控制等方面。
在这篇文章中，我们将详细介绍美国医院健康管理制度的具体内容以及其对医院运作和患者医疗服务的影响。
一、医院健康管理制度的政府监管美国的医疗制度是由联邦政府和州政府共同管理的，医院健康管理制度也是受到政府监管的。
在医院内部，联邦和州政府设立了专门的机构来监督医院的运营，保障患者的权益和医疗服务的质量。
在医院内部，联邦和州政府设置了一定的规章制度，要求医院必须遵守相关的卫生和安全标准、使用妥善的医疗设备和药品、采取必要的措施防止医疗误操作等。
另外，政府还设立了一些专门的管理机构来管理医疗卫生事务，对医院提供指导和建议。
这些机构包括美国医院协会(AHA)、美国护理协会(ANA)、美国医疗管理协会(AMGA)等。
这些机构会定期对医院的运营情况进行评估，并提出改进建议，以确保医院的健康管理制度能够得到有效的执行。
二、医院健康管理制度内部管理体系在医院内部，医院健康管理制度也有一套相对完善的管理体系。
通常而言，医院的管理团队由医院的董事会、医院行政管理人员和临床专业人员等构成。
这些人员按照各自的职责分工，共同负责医院的运营和管理。
在医院内部，医院的董事会拥有最终的管理权力，他们会负责监督医院的财务状况、人员招聘、机构建设、医疗质量等方面。
除此之外，医院的行政管理人员则负责具体的医院管理工作，包括医院内部的组织架构、人员管理、预算管理、采购管理等。
而临床专业人员则负责医疗服务的提供以及医疗质量的保障。
他们会根据医院的需求，提供相应的医疗服务，并不断优化医疗流程和服务质量，以满足患者的需求。
三、医院健康管理制度对患者医疗服务的影响医院健康管理制度的健全性将直接影响到患者的医疗服务质量。
在美国，由于政府监管的力度和医院内部管理的完善性，医院的医疗服务质量普遍较高，医疗设备和药品都得到了充分的保障和监管，医疗服务流程也相对规范。
US health care system 美国医疗保险体系介绍
Medicare Program - General InformationMedicare is a health insurance program for:∙people age 65 or older,∙people under age 65 with certain disabilities, and∙people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis ora kidney transplant).Medicare has:Part A Hospital Insurance - Most people don't pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.Part B Medical Insurance - Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.Prescription Drug Coverage - Most people will pay a monthly premium for this coverage. Starting January 1, 2006, new Medicare prescription drug coverage will be available to everyone with Medicare. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.Medicare Part AMedicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Certain conditions must be met to get these benefits.Cost: Most people don’t have to pay a monthly payment, called a premium, for Part A. This is because they or a spouse paid Medicare taxes while working. If a beneficiary doesn't get premium-free Part A, they may be able to buy it if they (or their spouse) aren’t entitled to Social Security, because they didn’t work or didn’t pay enough Medicare taxes while working, are age 65 or older, or are disabled but no longer get free Part A because they returned to work.Medicare Part BMedicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.Cost: The Medicare Part B premium each month ($99.90 per month in 2012). In some cases, this amount may be higher if the beneficiary didn't sign up for Part B when they first became eligible.Caution: If the beneficiary didn't take Part B when they were first eligible, the cost of Part B will go up 10% for each full 12-month period that they could have had Part B but didn't sign up for it, except in special cases. They will have to pay this penalty as long as they have Part B.They also pay a Part B deductible each year before Medicare starts to pay its share. The Part B deductible for 2012 is $140.00. The beneficiary may be able to get help from their state to pay this premium and deductible.Medicare deductible and premium rates may change every year in January.Medicare Advantage PlansA Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and PartB benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.Health Maintenance Organization (HMO) PlanIn most HMO Plans, you can only go to doctors, other health care providers, or hospitals on the plan's list except in an emergency. You may also need to get a referral from your primary care doctor.Can you get your health care from any doctor, other health care provider, or hospital?In HMO Plans, you can't get your health care from any doctor, other health care provider, or hospital. You generally must get your care and services from doctors, other health care providers, or hospitals in the plan's network (except emergency care, out-of-area urgent care, or out-of-area dialysis). In some plans, you may be able to go out-of-network for certain services, usually for a higher cost. This is called an HMO with a point-of-service (POS) option.Are prescription drugs covered?In most cases, prescription drugs are covered in HMO Plans. Ask the plan. If you want Medicare prescription drug coverage (Part D), you must join an HMO Plan that offers prescription drug coverage.Do you need to choose a primary care doctor?In most cases, yes, you need to choose a primary care doctor in HMO Plans.Do you have to get a referral to see a specialist?In most cases you have to get a referral to see a specialist in HMO Plans. Certain services, like yearly screening mammograms, don't require a referral.What else do you need to know about this type of plan?∙If your doctor or other health care provider leaves the plan, your plan will notify you. You can choose another doctor in the plan.∙If you get health care outside the plan's network, you may have to pay the full cost.∙It's important that you follow the plan's rules, like getting prior approval for a certain service when needed.Preferred Provider Organization (PPO) PlansHow PPO Plans WorkA Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurancecompany. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. You pay more if you use doctors, hospitals, and providers outside of the network.Can you get your health care from any doctor, other health care provider, or hospital?In most cases, you can get your health care from any doctor, other health care provider, or hospital in PPO Plans. PPO Plans have network doctors, other health care providers, and hospitals.Each plan gives you flexibility to go to doctors, specialists, or hospitals that aren't on the plan's list, but it will usually cost more.Are prescription drugs covered?In most cases, prescription drugs are covered in PPO Plans. Ask the plan. If you want Medicare drug coverage, you must join a PPO Plan that offers prescription drug coverage. Remember, if you join a PPO Plan that doesn't offer prescription drug coverage, you can't join a Medicare Prescription Drug Plan (Part D).Do you need to choose a primary care doctor?You don't need to choose a primary care doctor in PPO Plans.Do you have to get a referral to see a specialist?In most cases, you don't have to get a referral to see a specialist in PPO Plans. If you use plan specialists, your costs for covered services will usually be lower than if you use non-plan specialists.What else do you need to know about this type of plan?A PPO Plan isn't the same as Original Medicare or a Medicare Supplement Insurance (Medigap) policy.PPO Plans usually offer extra benefits than Original Medicare, but you may have to pay extra for these benefits.Medicare Special Needs Plans (SNP)How Medicare SNPs workMedicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.Can I get my health care from any doctor, other health care provider, or hospital?Generally, you must get your care and services from doctors or hospitals in the Medicare SNP network (except emergency or urgent care, such as care you get for a sudden illness or injury that needs medical care right away, or if you have End-Stage Renal Disease (ESRD) and needout-of-area dialysis). Medicare SNPs typically have specialists in the diseases or conditions that affect their members.Are prescription drugs covered?All SNPs must provide Medicare prescription drug coverage.Do I need to choose a primary care doctor?In most cases, SNPs may require you to have a primary care doctor, or the plan may require you to have a care coordinator to help with your health care.Do I have to get a referral to see a specialist?In most cases, you have to get a referral to see a specialist in SNPs. Certain services, like yearly screening mammograms or an in-network pap test and pelvic exam (covered at least every other year), don't require a referral.What else do I need to know about this type of plan?A plan must limit membership to these groups: 1) people who live in certain institutions (like anursing home) or who require nursing care at home, or 2) people who are eligible for both Medicare and Medicaid, or 3) people who have specific chronic or disabling conditions (like diabetes,End-Stage Renal Disease (ESRD), HIV/AIDS, chronic heart failure, or dementia). Plans may further limit membership. You can join a SNP at any time.Plans should coordinate the services and providers you need to help you stay healthy and follow doctor’s or other health care provider’s orders.If you have Medicare and Medicaid, your plan should make sure that all of the plan doctors or other health care providers you use accept Medicaid.If you live in an institution, make sure that plan providers serve people where you live.∙HMO Point of Service (HMOPOS) Plans: An HMO Plan that may allow you to get some services out-of-network for a higher cost.∙Medical Savings Account (MSA) Plans: A plan that combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.Part A costsYou usually don't pay a monthly premium for Medicare Part A (Hospital Insurance) coverage if you or your spouse paid Medicare taxes while working. This is sometimes called "premium-free Part A."How much does Part A cost?If you buy Part A, you'll pay up to $451 each month in 2012. In 2013, you'll pay up to $441 each month. But, most people get premium-free Part A. You can get premium-free Part A at 65 if:∙You already get retirement benefits from Social Security or the Railroad Retirement Board.∙You're eligible to get Social Security or Railroad benefits but haven't filed for them yet.∙You or your spouse had Medicare-covered government employment.If you're under 65, you can get premium-free Part A if:∙You got Social Security or Railroad Retirement Board disability benefits for 24 months.∙You have End-Stage Renal Disease (ESRD) and meet certain requirements.In most cases, if you choose to buy Part A, you must also have Medicare Part B (Medical Insurance) and pay monthly premiums for both.Some people automatically get Medicare Part A (Hospital Insurance).Part B costsYou pay a premium each month for Medicare Part B (Medical Insurance). Most people will pay the standard premium amount. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay more.How much does Part B cost?Most people pay the Part B premium of $99.90 each month in 2012 ($104.90 in 2013).You pay $140 per year for your Part B deductible in 2012 ($147 in 2013).Some people automatically get Part B.If you don't sign up for Part B when you're first eligible, you may have to pay a late enrollment penalty.If your modified adjusted gross income as reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain amount, you may pay more.Social Security will contact some people who have to pay more depending on their income. The amount you pay can change each year depending on your income. If you have to pay a higher amount for your Part B premium and you disagree (for example, if your income goes down), please contact Social Security.Costs for Medicare drug coverageYou'll make these payments throughout the year in a Medicare drug plan:∙Monthly premium∙Yearly deductible∙Copayments or coinsurance∙Costs in the coverage gap∙Costs if you get Extra Help∙Costs if you pay a late enrollment penaltyYour actual drug plan costs will vary depending on:∙The drugs you use∙The plan you choose∙Whether you go to a pharmacy in your plan's network∙Whether the drugs you use are on your plan's formulary∙Whether you get Extra Help paying your Medicare Part D costsIf you have limited income and resources, your state may help you pay for Part A and/or Part B.You may also qualify for Extra Help to pay for your Medicare prescription drug coverage.Costs for Medicare health plansWhat you pay in a Medicare health planYour out-of-pocket costs in a Medicare Advantage Plan (Part C) depend on:∙Whether the plan charges a monthly premium.∙Whether the plan pays any of your monthly Medicare Part B (Medical Insurance) premium.∙Whether the plan has a yearly deductible or any additional deductibles.∙How much you pay for each visit or service (copayment or coinsurance). For example, the plan may charge a copayment, like $10 or $20 every time you see a doctor. These amounts can be different than those under Original Medicare.∙The type of health care services you need and how often you get them.∙Whether you go to a doctor or supplier who accepts assignment (if you're in a PPO, PFFS, or MSA plan and you go out-of-network).∙Whether you follow the plan's rules, like using network providers.∙Whether you need extra benefits and if the plan charges for it.∙The plan's yearly limit on your out-of-pocket costs for all medical services.∙Whether you have Medicaid or get help from your state.NoteEach year, plans establish the amounts they charge for premiums, deductibles, and services. The plan (rather than Medicare) decides how much you pay for the covered services you get. What you pay the plan may change only once a year, on January 1.What does Medicare Part A cover?What is covered?Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease or condition.If you're in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.In general, Part A covers:∙Hospital care∙Skilled nursing facility care∙Nursing home care (as long as custodial care isn't the only care you need)∙Hospice∙Home health services2 ways to find out if Medicare covers what you need1. Talk to your doctor or other health care provider about why you need certain services orsupplies, and ask if Medicare will cover them. If you need something that's usually covered andyour provider thinks that Medicare won't cover it in your situation, you'll have to read and sign a notice saying that you may have to pay for the item, service, or supply.2. Find out if Medicare covers your item, service, or supply.Medicare coverage is based on 3 main factors1. Federal and state laws.2. National coverage decisions made by Medicare about whether something is covered.3. Local coverage decisions made by companies in each state that process claims for Medicare.These companies decide whether something is medically necessary and should be covered in their area.What does Medicare Part B cover?What's covered?Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease or condition.If you're in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.Part B covers 2 types of services∙Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.∙Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.Part B covers things like:∙Clinical research∙Ambulance services∙Durable medical equipment∙Mental health∙Inpatient∙Outpatient∙Partial hospitalization∙Getting a second opinion before surgery∙Limited outpatient prescription drugs2 ways to find out if Medicare covers what you need∙Talk to your doctor or other health care provider about why you need certain services or supplies, and ask if Medicare will cover them. If you need something that's usually covered and yourprovider thinks that Medicare won't cover it in your situation, you'll have to read and sign a notice saying that you may have to pay for the item, service, or supply.∙Find out if Medicare covers your item, service, or supply.Medicare coverage is based on 3 main factors1. Federal and state laws.2. National coverage decisions made by Medicare about whether something is covered.3. Local coverage decisions made by companies in each state that process claims for Medicare.These companies decide whether something is medically necessary and should be covered in their area.What drug plans coverEach Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost.A drug in a lower tier will generally cost you less than a drug in a higher tier. In some cases, if yourdrug is on a higher tier and your prescriber thinks you need that drug instead of a similar drug on a lower tier, you or your prescriber can ask your plan for an exception to get a lower copayment.Medicare Advantage Plans cover all Medicare servicesWhat is a Medicare health plan? A plan offered by a private company that contracts with Medicare to provide Part A and Part B benefits to people with Medicare who enroll in the plan. Medicare health plans include all Medicare Advantage Plans, Medicare Cost Plans, Demonstration/Pilot Programs, and Programs of All-inclusive Care for the Elderly (PACE).In all types of Medicare Advantage Plans, you're always covered for emergency and urgently needed care. Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you're in a Medicare Advantage Plan.The plan can choose not to cover the costs of services that aren't medically necessary under Medicare. If you're not sure whether a service is covered or not, check with your provider before you get the service.Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan. Most people pay the Part B premium of $99.90 each month in 2012 ($104.90 in 2013).If you need a service that the plan says isn't medically necessary, you may have to pay all the costs of the service, but you have the right to appeal the decision.You can also ask the plan for a written advance coverage decision to make sure a service is medically necessary and will be covered. If the plan won't pay for a service you think you need, you'll have to pay all of the costs if you didn't ask for an advance coverage decision.MedicaidA state and federal partnership, Medicaid provides coverage for people with lower incomes, older people, people with disabilities, and some families and children. Learn more about the program in this section.What is Medicaid?Each state operates a Medicaid program that provides health coverage for lower-income people, families and children, the elderly, and people with disabilities.The eligibility rules for Medicaid are different for each state, but most states offer coverage for adults with children at some income level. In addition, beginning in 2014, most adults under age 65 with individual incomes up to about $15,000 per year will qualify for Medicaid in every state.How can I get Medicaid?You may be eligible for benefits through Medicaid. Medicaid programs vary by state, so you will need to check with your state Medicaid office for more information.∙Eligibility: People with disabilities are eligible in every state. In some states, people with disabilities qualify automatically if they get Supplemental Security Income (SSI) benefits.In other states you may qualify depending on your income and resources (financialassets).∙“Buy-Ins”:Some states also have “buy-in” programs that allow people with disabilities with incomes above regular Medicaid limits to enroll in the Medicaid program. Childrenwith disabilities can qualify for Medicaid either under these disability-related rules, orbased on family income.∙Expansion in 2014. Starting in 2014, the Affordable Care Act will expand the Medicaid program to cover people under age 65, including people with disabilities, with income ofabout $15,000 for a single individual (higher incomes for couples and families withchildren).∙Help for disabled people: This expansion helps low-income adults who have disabilities but don’t meet the disability requirements of the SSI program. The expansion also helpsthose whose income is above their state’s current eligibility levels.What does Medicaid cost?Medicaid coverage is designed to be affordable for everyone who is eligible. Cost sharing for Medicaid varies by state but is extremely limited for most participants.What does Medicaid cover?The benefits covered for adults through Medicaid are different in each state, but certain benefits are covered in every Medicaid program.Doctor’s services that are covered by Medicaid include:Laboratory and X-ray servicesInpatient hospital servicesOutpatient hospital servicesHealth screenings for children and treatment if medical problems are identifiedComprehensive dental and vision services for childrenFamily planning services and suppliesLong-term care services and supportsMedical and surgical dental services for adultsPediatric and family nurse practitioner servicesServices provided in health clinicsNurse-midwife servicesNursing facility services for adultsHome health care services for certain peoplePrescription drugsOther benefits your state must cover for children and may cover for adults:Physical, occupational, or speech therapyEye doctor visits, eyeglassesAudiology, hearing aidsProsthetic devicesMental health servicesRespite and other in-home long-term careCase managementPersonal care servicesHospice servicesThe Affordable Care Act will expand options for community-based care. There will be more opportunities for people of all ages who have a disability to get help with daily activities while remaining in their homes. The Medicaid program continues to move toward providing more community-based care options as an alternative to nursing homes.What special Medicaid coverage is available to women?Cancer Prevention and TreatmentBreast and Cervical Cancer Prevention and Treatment (BCCPT) Medicaid programs are available to eligible women who are diagnosed with either breast and/or cervical cancer through the state screening program. You may be eligible even if you have a higher income. States have flexibility to define what it means to have been diagnosed or screened under the program.Medicaid Options for Pregnant WomenPregnant women may have special eligibility for Medicaid coverage for themselves and their infants at little or no cost if they have limited income.Medicaid eligibility for pregnant women varies by state, but all states must cover pregnant women with incomes up to about $20,000 as an individual. Most states cover pregnant women under Medicaid with higher incomes, and some states cover pregnant women under the Children’s Health Insurance Program (CHIP).EligibilityMedicaid and CHIP provide health coverage to nearly 60 million Americans, including children, pregnant women, parents, seniors and individuals with disabilities. In order to participate in Medicaid, federal law requires states to cover certain population groups (mandatory eligibility groups) and gives them the flexibility to cover other population groups (optional eligibility groups). States set individual eligibility criteria within federal minimum standards. States can apply to CMS for a waiver of federal law to expand health coverage beyond these groups.Many states have expanded coverage, particularly for children, above the federal minimums. For many eligibility groups, income is calculated in relation to a percentage of the FederalPoverty Level (FPL). For example, 100% of the FPL for a family of four is $22,350 in 2011. The Federal Poverty Level is updated annually. For other groups, income standards are based on income or other non-financial criteria standards for other programs, such as the Supplemental Security Income (SSI) program.In accordance with CHIPRA section 213, CMS published a notice in Federal Register on December 18, 2009, (Vol. 74, No. 242) soliciting comments to assist in the development of a model process. CMS invites feedback from stakeholders regarding the viability of the proposal on interstate coordination.Affordable Care Act of 2010 Expands Medicaid Eligibility in 2014The Affordable Care Act of 2010, signed by President Obama on March 23, 2010, creates a national Medicaid minimum eligibility level of 133% of the federal poverty level ($29,700 for a family of four in 2011) for nearly all Americans under age 65. This Medicaid eligibility expansion goes into effect on January 1, 2014 but states can choose to expand coverage with Federal support anytime before this date-see related Federal Policy Guidance and states that have expanded Medicaid prior to 2014. See eligibility provisions in the Affordable Care Act.Other Eligibility CriteriaThere are other non-financial eligibility criteria that are used in determining Medicaid eligibility. In order to be eligible for Medicaid, individuals need to satisfy federal and state requirements regarding residency, immigration status, and documentation of U.S. citizenship.Retroactive EligibilityMedicaid coverage may start retroactively for up to 3 months prior to the month of application, if the individual would have been eligible during the retroactive period had he or she applied then. Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.Premiums, Copayments, & other Cost SharingStates have the option to charge premiums and to establish out of pocket spending (cost sharing) requirements for Medicaid enrollees. Out of pocket costs may include copayments, coinsurance, deductibles, and other similar charges. Maximum out of pocket costs are limited, but states can impose higher charges for targeted groups of somewhat higher income people. Certain vulnerable groups, such as children and pregnant women, are exempt from most out of pocket costs, and copayments and coinsurance cannot be charged for certain services.。
中美医疗体系对比英语作文
中美医疗体系对比：差异与启示**Introduction**Healthcare is a critical component of any society, and the United States and China, being two of the most populous and economically powerful nations, have their unique healthcare systems. While the American healthcare system is often praised for its innovation and technology, the Chinese system is admired for its efficiency and coverage. This essay aims to compare the healthcare systems of both countries, highlighting their differences and similarities, and discussing the implications for global healthcare.**Healthcare System in the United States**The US healthcare system is known for its diversity and market-driven approach. Private insurance companies play a significant role, with most individuals obtaining coverage through their employers or purchasing private insurance. This system ensures access to advanced medical technology and innovative treatments, often at the forefront of medical research. However, the cost of healthcare in the US is notoriously high, with private insurance premiums anddeductibles often being a significant financial burden. Furthermore, the system faces challenges such as uninsured individuals, disparities in access to care, and rising healthcare costs.**Healthcare System in China**In contrast, the Chinese healthcare system is more centralized and government-led. Universal health insurance covers the majority of the population, ensuring access to basic healthcare services. This system emphasizes primary care and preventive medicine, aiming to reduce the burden of chronic diseases and improve overall population health. The Chinese government has also invested heavily in medical technology and infrastructure, resulting in improved healthcare outcomes. However, the system faces challenges such as resource allocation, quality of care, and rising healthcare costs.**Comparison and Implications**The main difference between the two systems lies in their approach to healthcare delivery. The US system relies heavily on private insurance and market forces, while the Chinese system is more centralized and government-led. Thisdifference is reflected in the cost, access, and quality of healthcare services.The US system, while innovative and technologically advanced, faces significant financial challenges. The high cost of healthcare is a major concern, with private insurance premiums and deductibles often being unaffordable for many Americans. This issue is exacerbated bydisparities in access to care, with rural and underserved areas often lacking sufficient healthcare resources.In contrast, the Chinese system ensures universal access to basic healthcare services through government-led insurance schemes. This approach ensures that the majority of the population has access to necessary healthcare services, reducing disparities in access. However, the system faces its own challenges, such as resourceallocation and quality of care.The implications of these differences are significant for global healthcare. The US system, while innovative, needs to address financial challenges and disparities in access to care. The Chinese system, while ensuring universal access, needs to improve resource allocation andquality of care. Both systems can learn from each other, adopting best practices and innovations to improve healthcare outcomes.**Conclusion**In conclusion, the healthcare systems of the United States and China differ significantly in their approach, cost, access, and quality of care. While each system has its own advantages and challenges, there are valuable lessons that can be learned from each other. By comparing and analyzing these systems, we can gain insights into the future of healthcare and how to improve it globally.。
美国和中国医疗系统区别英语作文
美国和中国医疗系统区别英语作文Healthcare systems in the United States and China have significant differences due to their different economic, political, and social contexts. In this essay, we will explore the disparities between the two healthcare systems in terms of financing, access, quality of care, and patient outcomes.Firstly, let's examine the financing of healthcare in both countries. In the United States, the healthcare system is primarily driven by private insurance companies and individualout-of-pocket payments. This results in a high cost of healthcare services, making it difficult for many Americans to afford necessary medical care. In contrast, China has a socialized healthcare system where the government plays a significant role in financing and providing healthcare services. This results in lower costs for patients and greater access to care for the general population.Secondly, access to healthcare in the two countries differs significantly. In the United States, access to healthcare is often limited by insurance coverage, leading to disparities in healthcare access based on income and employment status. On the other hand, China has made significant strides in recent years to improve healthcare access for its citizens through theexpansion of healthcare facilities and the implementation of universal health insurance coverage. This has resulted in improved access to care for all Chinese citizens, regardless of their socioeconomic status.The quality of healthcare services also varies between the United States and China. In the United States, healthcare is often considered to be among the best in the world, withstate-of-the-art facilities and highly trained medical professionals. However, the high cost of healthcare services can result in disparities in quality of care based on patients' ability to pay. In China, while the quality of healthcare services has improved significantly in recent years, there are still concerns about the quality of care in rural areas and the capacity of the healthcare system to handle the growing demands of the population.Lastly, let's consider the patient outcomes in both countries. In the United States, despite the high cost of healthcare services, the country lags behind other developed nations in terms of key health indicators such as life expectancy and infant mortality rates. This is often attributed to disparities in healthcare access and the high prevalence of chronic diseases such as obesity and diabetes. In contrast, China has seen significant improvements inpatient outcomes in recent years, with increasing life expectancy and decreasing mortality rates due to improvements in healthcare access and quality of care.In conclusion, the healthcare systems in the United States and China have significant differences in terms of financing, access, quality of care, and patient outcomes. While the United States has a highly privatized healthcare system with high costs and disparities in access, China has a socialized healthcare system with lower costs and improved access for all citizens. Both countries face challenges in providing quality healthcare services to their populations, but there are valuable lessons to be learned from the strengths and weaknesses of each system.。
过来人讲述美国的医疗体制
过来人讲述美国的医疗体制在朋友圈里曾发过几张我拍摄的美国公立医院，很多人惊叹比星级宾馆的条件都要好，我不禁哑然失笑。
其实想写这个题目由来已久，但总被其他事情打断，直到最近连续有几个网友留言，说在中国人当中流传着一种说法，“在美国看病比中国难，因为要预约，等约到了人也病死了”，请我最好证实一下真伪，看来我非得写写美国的医疗体制了。
首先不错的是，美国的医院和诊所是预约制，一个医生每天能看的病人数目有限，预约是为了保证每个病人都能享受到完善的诊断和治疗。
其次，美国是家庭医生为主的制度，有病只要不是急诊不会直接上医院，而是先去家庭医生或专科医生的诊所。
家庭医生属综合科类，主要以预防为主、治疗为辅，包括教育病人怎样预防疾病、坚持健康生活、定期检查、跟进监测病人的生活方式和现有疾病，同时治疗感冒、发烧等小病小灾。
一旦有什么疑问或搞不定的，家庭医生会尽快将你转到专科医生、地区或大医院去，因为医院里有先进的诊断技术和手术室等。
家庭医生是美国医生的中坚力量，受过和其他医生同样严格的医学训练，病人需要见自己家庭医生的话，一般都能得到当天的预约。
另外，家庭医生在美国的概念很广泛，小孩儿的家庭医生是儿科医生，妇女或产妇除家庭医生外还另有一个妇科医生，眼科和牙科在美国属不同的系统，因此，美国人也可能有自己的眼科和牙科家庭医生。
最后，如果你的病来得突然等不及预约，可以直接开车或叫救护车到医院急诊室，那里可以马上提供医疗服务。
同时，多数的美国社区里还有一种叫做“紧急医疗”(Urgent Care)的诊所，供周末或夜里医生不上班时，那些没有严重到去急诊室但又需要马上医疗处理的病人使用。
由此可见，在美国根本不可能发生“等约到了人也病死了”的事情。
美国的医院有两种，公立和私立医院。
美国公立医院规模很大，它们接受地方、州和(或)联邦政府拨款，同时治疗的病人也可由联邦医疗援助(Medicaid)、联邦医保(Medicare)或私营医疗保险公司支付。
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Payers must compete for Patient business.
Each market must have multiple Payers (A, B, and C insurance companies)
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Health Insurance
National Health Plan
National Health Plan is an entitlement program not subject to above concerns and should be lower cost to implement.
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Health Insurance Companies Keep Provider Costs Down
Physician contracting Hospital contracting Formulary
This removes all “extra benefits” from providers and allow health insurance companies to, in theory, pass the benefits to consumers. 这排除了服务提供方的“额外收益”，而将此利益让渡给医疗保险公 司，理论上说，是消费者受益。
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Differences between Health Insurance and National Health Plan Health insurance companies are private business with P&L responsibilities Adverse selection Pre-existing condition • Click to add Text Investment in health improvement Text • Click to add
National Health Care
Current stakeholders who stand to lose
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Timeline of Obama Care
2010 - 2011 2013 - 2014
People under 26 can Health plans must offer electronic be covered by records parents No pre-existing No pre-existing conditions, health condition for children status, nor gender Life time / annual Citizens pay fine for limits removed not joining health No policy cancellation insurance after a person gets ill Employers pay fine for not offering health insurance
Pay claims submitted by providers. Establish “reasonable and customary” fee schedule. Provider contracting based on price and quality. Manage care through pre-authorization, referrals, case management, and preventive care.
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Why Do We Need Health Insurance?
High cost at unpr源自dictable frequency
80-20 rule
Current money for current needs
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A Private Third Party Payer is the key to keep US Health Care System in Balance
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Competition after Privatization
Each market must have multiple Provider networks.
Compete on both price and quality
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Medicare and Medicaid
Federal Government is by far the largest payer through Medicare and Medicaid. Medicare is for people 65 years of age and older. Medicare spending will more than double in the next decade, from $309 billion in 2004 to $792 billion in 2015. Medicaid spending is expected to increase from $293 billion to $670 billion during the same period
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What benefits health insurance companies
People stay healthy
Diseases are diagnosed early Minimize disease complications
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What Do Patients Do? Uninsured: seek emergency care or Medicaid Insured: Choose a family doctor Family doctor becomes the “care manager” Family doctor must make referral to hospitals Make co-pay as defined by payers (office visits, generic / brand name drug, out-of-pocket maximums, etc.)
US Health Care Reform Map
Proponents 赞成方 People Businesses Government Obstacles 阻碍方 Current US Status High cost High quality for the rich 15% uninsured
Patient 患者
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Providers
Doctors Hospitals Laboratories Pharmacies Pharmaceutical Companies (formularies) Home care and other specialty care
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What Do Providers Do? Family doctors: one-to-one relationship Specialists: specialty care Hospitals: inpatient and emergency care Drug stores: drug prescriptions Pharmaceutical companies: drugs under a “formulary” arrangement
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Patient
Choose health insurance programs. People over 65 are covered by Medicare. People under a certain poverty line are covered by Medicaid. Enroll annually (with some exceptions). Still left 15% of the population “uninsured.”
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US Health Care System
US Health Care Spending
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Three Main Parties in Health Care Payer 支付方
Service Provider 服务提供方
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Payers
Government: Medicare and state Medicaid programs Health insurance programs / HMO Patients
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What Do Payers Do?
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