美国管理式医疗的发展历程及对国内医保的借鉴

从理论和实证的研究表明,管理式医疗曾被当作美国医疗保险改革的典范,甚至有人尊其为有效降低医疗费用和成本的灵丹妙药。在有效控制节节攀升的医疗服务费用方面,管理式医疗确实达到了非常好的效果。但是,医疗服务需要关注的不仅是费用,还有医疗服务的质量、服务的可及性以及临床医疗的长远发展等方面。而美国管理式医疗的发展历程生动地诠释了普通民众需要的不仅仅是廉价的医疗服务这一现实。

The development history of managed care in USA and lessons to China

Both the theories and empirical studies have confirmed the fact that managed care was used to be regarded as the model of health insurance reform in United States, and even as the Panacea reducing medical expenditure and cost effectively. In the term of effective control of the increasing medical expenditure, managed care has achieved excellent results. But what the medical services concern is not just the expenditure but the quality, the accessibility, the future development of medical service, and so on. Therefore, the development history of managed care in United States has offered a vivid explanation to the fact that the medical service ordinary people needed is beyond the cheap.