新医改中英文对照评论
奥巴马的新医保计划(中英对照)
原文The President’s PlanPublished: February 22, 2010Perhaps if Senator Edward Kennedy had lived longer, or the election to choose his successor had turned out differently, President Obama’s decision to have Congress take the lead on health care reform would have looked like a political masterstroke. It didn’t turn out that way.It is a relief to see Mr. Obama fully engaged.The president was right to invite Republican leaders to a health care summit this week. He should hear them out but also challenge them — directly — to come up with credible ideas that would both expand coverage for tens of millions of uninsured Americans and begin to rein in out-of-control medical costs. For too long they have been allowed to obstruct and demagogue.And Mr. Obama will need to keep pushing in the days that follow and stiffen the spines of any wavering Democrats.Most important, Mr. Obama needs to clearly explain the stakes to the American people. Reform is essential for Americans who have no health insurance. But it is just as crucial to the millions more who are just one layoff away from losing their coverage, and many millions more who watch with fear as the cost of care and their insurance premiums rise relentlessly.•Mr. Obama took an important step on Monday by issuing, at long last, his own detailed proposals for reform.The most basic facts to keep in mind are that Mr. Obama’s plan, which builds on a sound bill already passed by the Senate, would provide coverage to morethan 30 million uninsured people while reducing future deficits and beginning to rein in medical costs.Mr. Obama’s plan also adds important new features that should make it more attractive to House Democrats and to the general public.His boldest new idea is to give the federal government powers, in conjunction with state insurance regulators, to reject excessive premium increases. Anyone who read in horror, as we did last week, about rate increases of up to 39 percent for some California clients of Anthem Blue Cross should find that idea a particular relief.For low- and moderate-income people worried that they will be forced to buy insurance they can’t afford, a proposal of his would beef up tax subsidies to help them buy policies and make the penalties for ignoring the mandate somewhat less onerous.For older Americans, Mr. Obama would gradually close the so-called doughnut hole, a gap in Medicare’s drug coverage that leaves many elderly beneficiaries unable to pay for their medicines.For deficit hawks, Mr. Obama would retain an important cost-control measure: a proposed tax on high-cost, employer-sponsored insurance policies. But he would make it more palatable to workers by raising the thresholds and delaying imposition of the tax for all workers — not just those in unions —until 2018. That retains its ability to lower costs over the long term.His plan also provides important relief for cash-strapped states that say they can’t afford to expand their Medicaid rolls — another essential step to covering the uninsured. It would give a generous matching-fund rate to all states to cover newly eligible enrollees, and it jettisons the special deal granted to Nebraska — to win Senator Ben Nelson’s vote — that would have hadWashington paying the full cost, in perpetuity, of just one state’s Medicaid expansion.•The president’s proposals are far from perfect. We wish he had included a public plan. And we regret that he accepted the Senate’s decision not to require employers to provide insurance. He would boost the payments required of employers whose workers end up needing public subsidies to help them buy their own coverage.In all, the administration estimates the cost of Mr. Obama’s proposals — $950 billion over 10 years — would be more than offset by new revenues and would reduce the deficit by $100 billion over the next decade and by about $1 trillion in the decade after that.As they consider all this, Americans also need to keep in mind what Republican leaders mean when they talk about health care reform. All of their ideas have these basic facts in common: they would not reduce the number of uninsured Americans substantially; they would not guarantee affordable coverage for people with pre-existing conditions; they make only feeble attempts to rein in medical costs; and their proposals to slow the rise in the cost of premiums would mostly benefit the healthy. That is not enough.Mr. Obama’s proposals provide a firm basis for both the Senate and House to move forward with comprehensive reforms. If the Republicans resort to filibusters to block passage, the Democrats should use a budget reconciliation procedure that requires only a majority vote for passage in the Senate.This may be the last best chance for decades to come to reform the nation’s broken health care system. Mr. Obama and Democratic leaders should fight to win.译文奥巴马的新医保计划Published: February 22, 2010要是参议员爱德华·肯尼迪（Edward Kennedy）目前依然健在，抑或选举其继任者的结果与现在不同的话，那么奥巴马总统要求国会率先支持医改方案的决策就如一招政治妙棋，而不会变成这个样子。
[精彩]医疗改革-五项重点改革英文版
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打印本文关闭窗口□□□□□□改□□□□□□□□□□2009□2011□□□□□文文章来源：国家发改委网站更新时间：2009-4-8 21:43:31□□□□□□□□□□□□□□□□□□□□r □□□□□□□□□□r□□r□□□□□□□□□□□□□□□□□□r□□□□□□□□□□□r□□2009-2011□According to the Opinions of the CPC Central Committee and the State Council on Deepening the Health Care System Reform (hereinafter referred as “the Opinions”), five reform programs should be carried out with emphasis from 2009 to 2011. Firstly, accelerate the establishment of the basic medical security system. Secondly, preliminarily set up the national essential medicines system. Thirdly, improve the grass-roots health care services system. Fourthly, grad ually press ahead with the equalization of basic public health services. And fifthly, push forward pilot projects for public hospital reform.The implementation of the five priority reform programs aims at effectively solving the problem of “difficult and costly access to health care services”, whi ch arouses intense public concerns. In promoting the establishment of basic medical security system, all urban and rural residents will be included into the s ystem to effectively reduce the burden of drug expenses on the individuals. In establishing the national essential medicines system, and improving the gras s-roots health care services system, it will be made more convenient for residents to accessing health care services; the role of the traditional Chinese medic ine (TCM) will be brought into full play and the prices of health care services and drugs be reduced. In promoting the gradual equalization of basic public h ealth services, all urban and rural residents should be entitled to basic public health services, for prevention of diseases to the maximum extent. In carrying out pilot projects for public hospital reform, efforts will be made to improve the service quality of public health care institutions and to meet the demand of the people to have “convenient and affordable access to health care services”.The implementation of the five priority reform programs aims at actualizing the commonweal nature of health care undertakings, and is characterized by th e salient phased features of a reform. Making the basic health care system as public goods to the general public and providing everyone with basic health ca re services, is a major reform from concept to institution in the development of China’s health care sector, which meets the fundamental requirement in imp lementing the Scientific Outlook on Development. As an arduous and long-term task, the health care system reform shall be promoted with specific emphas is in different phases. Fairness and effectiveness should be appropriately balanced. The fairness issue will be tackled at the early stage to guarantee the basi c demands of the people for health care services, which will be followed by a progressively increased benefit level along with the social and economic deve lopment. Efforts will be made to gradually address the issue of integration among the urban employees’ basic medical insurance, the urban residents’ basic medical insurance, and the New Rural Cooperative Medical Scheme. Social capital investment in the sector will be encouraged to develop multi-level diver sified health care services. Efforts will be made to utilize health care resources of the whole society in an all-round way to improve service effectiveness an d quality and meet the various demands for health care services of the people.The implementation of the five priority reform programs is to enhance the operability of the reform, highlight the priorities, and to push forward the compre hensive reform in the health care system. Establishing the basic health care system is an important institutional innovation, which is a pivotal step in the co mprehensive reform of the health care system. The five priority reform programs involve key links and areas such as building up the medical security syste m, secured pharmaceutical supply, price formation mechanism of health care services and drugs, construction of health care institutions at grass-roots level s, reform of public health care institutions, mechanism of investment in health care, development of the health care workers’ team, health care administratio n system and etc. The purpose of prioritizing the five reform programs is to fundamentally change the situation of no medical security for some urban and r ural residents and the chronic inadequacy of public health care services, reverse the profit-orientated behaviors of public health care institutions and drive th em to resume their commonweal nature, effectively tackle the prominent problems in the current health care sector, laying a solid foundation for realizing t he long-term objectives of the health care system reform.□□□□□□□□r□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□d□□□□□□□□r□□□□□□□□□(i) Expanding the coverage of the basic medical security The urban employees’ basic medical insurance (hereinafter abbreviated as UEBMI), the urban residents’ basic medical insurance (hereinafter abbreviated as URBMI), and the New Rural Cooperative Medical Scheme (hereinafter abbreviated as NRC MS) will cover all urban and rural residents within three years, each with the coverage rate over 90%. Retirees of closed-down and bankrupted enterprises a nd employees of enterprises in difficulties will be covered by UEBMI in about two years. Those who cannot be covered by UEBMI should be entitled to U RBMI, with the permission of provincial level government. Retirees of closed-down and bankrupted enterprises should be entitled to the benefits of the basi c medical insurance regardless of the premiums affordability by these enterprises. To enable insurance participation, appropriate subsidies shall be given by the central government to retirees of closed-down and bankrupted state-owned enterprises in financially constrained regions. The UEBMI system will be im plemented universally in 2009, which will also cover all the on-campus college students. Efforts should be made to vigorously promote UEBMI participatio n by employees of economic entities of non-public ownership, temporary contract workers and migrant rural workers. For those with employment difficulties, the government will subsidize their participation in UEBMI if they are eligible according to the Employment Promotion Law. Temporary contract worke rs should volunteer their participation in either UEBMI or URBMI. Those migrant rural workers with difficulty in participating UEBMI, can opt for URBM I, or NRCMS in their registered permanent residence.(ii)mproving the basic medical security level Efforts will be made to improve the fund-raising standard and benefit level of URBMI and NRCMS. By 2010, subsidy on URBMI and NRCMS by government budgets at various levels will be increased to 120 Y u an per person per annum, and premium paid by individuals should be appropriately increased, with specific standards set up by provincial governments. The proportion of hospitalization expenses reimbur sed by UEBMI, URBMI and NRCMS will be increased step by step within the scope of policy. The scope and proportion of reimbursement for outpatient e xpenses will be expanded. The maximum amount payable by UEBMI and URBMI shall be increased to about six times of annual average salary of local e mployees and disposable income of residents respectively. The maximum amount payable by NRCMS shall be increased to over six times of the per-capita net income of local farmers.(iii) egulating administration of basic medical security funds In the administration of various basic medical security funds, the principles of “determin ing expenditure by revenue, balancing expenditure and revenue and pursuing slight surplus” should be followed. Efforts should be made to maintain reason able control over annual balance and accumulated balance of UEBMI and URBMI accounts, and in localities where there is an over surplus of balance, mea sures such as raising the benefit level should be adopted to reduce the balance to a reasonable level step by step. For NRCMS, the surplus of the pooling fun d of the current year shall be capped within 15%, the accumulated surplus shall not exceed 25% of the current year’s pooling fund. The risk adjustment fun d shall be institutionalized for basic medical insurance funds. The fund balance status shall be made public regularly. The fund pooling for basic medical in surance shall be upgraded, and funds for UEBMI and URBMI respectively should be preliminarily pooled at the municipal (prefecture) level by 2011.(iv) mproving the urban and rural medical aid system Efforts should be made to effectively utilize medical aid funds and streamline procedures for ex amination, approval and the delivery of such funds. Financial assistance should be provided to members of urban and rural households receiving the minim um living standard allowance and those entitled to “five guarantees” to secure their participation in URBMI and NRCMS. For members of economically str ained households, the subsidization standards on out-of-pocket medical expenses will be gradually raised.(v) mproving service uality and management of basic medical security o cal governments should be encouraged to actively explore establishing a ne gotiation mechanism between medical insurance handling institutions and providers of health care services as well as reforming ways of payment, and to rat ionally determine the payment criteria for drugs, health care services and medical materials, and to containing the cost. Efforts should be made to improve medical security services, promote the application of the “All-in-One Card” (a multi-purpose card) among insurants, and realize direct settlement between medical insurance handling institutions and designated health care institutions. Farmers participating in NRCMS should be allowed to access designated he alth care institutions within the pooling area, and referral procedures for accessing health care services beyond the county should be streamlined. An accoun t settlement mechanism will be established for treatment from allopatry, and for relocated retired insurants, methods should be explored to settle account in the same locality where treatment is received. Efforts should be made to formulate methods of transferring and connecting basic medical insurance account s so that the problems in transferring basic medical security accounts from one region to another, or from one system to another, of those temporary contrac t workers including migrant workers, can be resolved. Proper connection should be made among UEBMI, URBMI, NRCMS and urban-rural medical aid. E fforts should be made to explore and set up an integrated basic medical security management system for urban and rural areas, and gradually integrate the a dministrative resources handling and managing basic medical security. On the premises of ensuring safety of the funds and effective supervision, efforts sh ould be made to explore entrusting qualified commercial insurers to provide various medical security management services in the way of government purch asing medical security services.□□□□r□□□□□□□r□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□d□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□d r□□d□□□□□□□□□□□□□□□□□□□□□□□□□□□□r □□□□□□□□□□□□□□□□□□□□□□□□□□□□d□□□□□□□□□□□□□□□□□d □□□□□□□□□□□□□□□d□□□r □□□□□□□□□□□□□□□□□□□d□□□□□□□□□□□d □□□□r□□□□□□d□□□□□□□□□□□□□□□□□□□□□d□□□□□□□□□□□□□ r□□d□□□□□d □□d □□d□□□d r□□□□□r□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□d□□□□□□□□□□□d □□□□□□□□□□□d □□□□r□□ 2009□(vii) reliminarily establishing a secured supply system for essential medicines Efforts should be made to bring into full play the role of market forces in pushing forward merger and restructuring of pharmaceutical manufacturing and distributing enterprises, and to develop unified distribution and achieve o perational scale; encourage retail pharmacies to develop chain operation. The professional pharmacist system should be improved and retail pharmacies, as of required, must be staffed with certified pharmacists, who can provide patients with consultation and guidance in purchasing drugs. Essential medicines u sed in government-run health care institutions, shall be purchased through open tender organized by institutions designated by provincial governments, and unified distribution by distributors selected through the open tender is also required. Manufacturers and distributors bidding for tender should have appropriate qualifications. In purchasing drugs through open tender and selecting distributors, the principles of nationwide unified market, equal participation and fa ir competition among enterprises of different ownerships and regions should be applied. Both the purchaser and seller should sign the contract according to the result of tender, and strictly implement the contract. Essential medicines required in small amount could be designated to manufacturers through tender. Efforts should be made to improve the national reserve system of essential medicines, strengthen supervisions over drug quality, and conduct sampling insp ection on the quality of drugs regularly and make the result open to the public.The central government determines the guiding retail prices of essential medicines. Based on the result of tender, provincial governments set the unified pur chasing prices within the range of the government-guided prices, with the distribution charge included in the purchasing price. G o vernment-run health care institutions at grass-roots levels shall sell drugs with zero mark up. L o cal governments are encouraged to explore purchasing means of further reducing the prices of essential medicines.(viii) Establishing priority selection and rational utili ation system for essential medicines To meet the demand of patients, all retail pharmacies and h ealth care institutions should store and sell the national essential medicines. The utilization rates of essential medicines in health care institutions at various levels should be regulated by government health departments. Starting from 2009, essential medicines should be stored and used in all government-run heal th care institutions at grass-roots levels. All other health care institutions must use essential medicines as regulated. H e alth departments of the government s hould formulate guidelines and prescription formularies of essential medicines for clinical use so as to strengthen guidance and supervision over medicatio n. Patients are allowed to purchase drugs in retail pharmacies with prescription. All the essential medicines are included in the drug reimbursement list of b asic medical security, with the reimbursing rate much higher than that of non-essential medicines.□□□□□□r□□□□□□□□□□□□□□□□□□□□□□□□□□r□□□r□□□□□□□□r□□□-r□□□□□□□□□□(ix) trengthening construction of grass roots health care institutions Efforts should be made to improve the three-tier rural health care service networ k, and give full play to county-level hospitals’ leading role. The central government will give full support to the construction of around 2000 county-level h ospitals (including TCM hospitals) within three years, and at least one hospital in each county should reach the level of a standard county hospital. Construc tion standards for township health care centers and community health centers should be improved. In 2009, the construction of 29,000 township health cent ers supported by the central government planning should be completed, and support will also be given to the renovation and expansion of over 5000 lead to wnship health centers, with one to three centers in each county. V i llage clinic construction in remote and border areas will be supported, and each administr ative village will be equipped with one clinic nationwide in three years. 3700 urban community health centers and 11,000 community health stations will ne wly built or renovated in three years. The central government will support the construction of 2400 urban community health centers in regions with difficult ies. The health care resources should be restructured in areas with excess public hospitals resources, for the purpose of strengthening health care institutions at grass-roots levels. Through ways of service purchasing, the government compensates public health services provided by grass-roots health care institutio ns run by non-government sponsors. The government will compensate basic health care services provided by non-government institutions through channels such as basic medical security funds and by means including signing designated health care insurance contract. Q u alified health care professionals are enco uraged to run clinics or establish their individual practice.(x) trengthening the team of grass roots health care or ers Efforts will be made to work out and implement the plans of free of training general prac titioners and recruitment of certified practitioners for rural areas. The plan is to train 360,000 health care professionals for township health centers, 160,000 for urban community health institutions and 1.37 million for village clinics in three years. The system of counterpart aid between urban and rural hospitals will be improved. Each urban tertiary hospital shall provide long-term counterpart assistance to about three county-level hospitals (including township healt h centers where conditions allow). Efforts will be made to implement the project of “10,000 doctors providing health care assistance to rural areas”, and im prove the quality of county-level doctors with further training in large urban hospitals, or with standardized training for resident physicians.Efforts will be made to effectively implement the policy that doctors in urban hospitals and disease prevention and control centers shall work for at least on e year in rural areas before obtaining intermediate or senior professional titles. G r aduates from medical universities are encouraged to work in health care in stitutions at grass-roots levels. Starting from 2009, the government will compensate tuition fees and student loans for those medical graduates who voluntee r to work for at least three years in township health centers in mid-western regions.□xi) eforming the compensation mechanism for health care institutions at grass roots levels The operational costs of health care institutions at grass-roots levels shall be compensated through service charges and government subsidies. W i th regard to government-run township health centers, urban commu nity health centers and stations, the government is responsible for their basic construction, equipment purchase, staffing costs, and public health service cost s, in accordance with state regulations, and the compensation will be delivered through ways such as fixed amount funding for designated items and service purchasing. The salary level of health care workers should be in line with the average salary level of staff of local public institutions. The service charges ofgrass-roots health care institutions shall be set according to the costs after deduction of government subsidy. As long as drugs are sold at zero price margin, the revenue from drug sale will no longer be compensation sources for funding grass-roots health care institutions, and drug discount shall not be accepted. Efforts will be made to explore separated management of expenditure and revenue of health care institutions at grass-roots levels.The government provides rational subsidies to rural doctors for providing public health services. The criteria shall be regulated by the local government.(xii) ransforming the operation mechanism of health care institutions at grass roots levels e alth care institutions at grass-roots levels shall provide low-cost services for urban and rural residents by using appropriate techniques, appropriate equipments as well as essential medicines, and promoting the us e of TCM including ethnic minority traditional medicines. Township health centers shall change their way of services, organizing mobile medical teams to r ural areas. The urban community health centers and stations shall provide on-the-spot services and household visits for patients whose movement is restrict ed because of illness. L o cal governments are encouraged to formulate diagnosis and treatment criteria for health care institutions at different levels, carry o ut pilot projects of “initial diagnosis at community health centers”, and establish dual referral between grass-roots health care institutions and superior hospi tals. Efforts will be made to completely implement staff recruitment system, establish the human resources management system that allows two-way move ment of staff flow, improve the income distribution system, and establish the evaluation and incentive system with service quality and quantity as the core, and job responsibility and performance as the basis.□□□□r□□□□□□□□□□□r□d□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□r□□□□□(xiii) overing both urban and rural residents ith basic public health services The items of basic public health services will be defined and the conten t of services specified. Starting from 2009, residents’ health record will be gradually established with standardized management nationwide. Actions should be taken to conduct regular health checkup for senior citizens over 65, carry out regular growth checkup for infants and children under three, conduct regula r prenatal examination and postnatal visit for pregnant and lying-in women, and provide guidance of prevention and control to patients with diseases such a s hypertension, diabetes, mental disorders, H I/AIDs, and tuberculosis. Efforts will be made to disseminate health care knowledge, and establish CCTV health channel in 2009. Both central and local media shall intensify publicity and education on health care knowledge.(xiv) ncreasing ma or national programs of public health services Efforts will be made to continue implementing major public health programs such a s prevention and control of major diseases including tuberculosis and H I/AIDs, national immunization program, hospitalized delivery for women in rural areas. The following projects will be launched starting from 2009: supplementary vaccination of H e patitis B for individuals under 15; eliminating the hazards toxication by coal-burning fluorosis, supplementary intake of folic acid for rural women at the preconception and early pregnant stage for the purpose of preventing birth defect; cataracts cure for economically constrained patients; improving water supply and toilet facilities in rural areas.(xv) trengthening capacity building of public health services Priority will be given to improving facilities of specialized public health institutions for mental health care, maternity and child heath care, health supervision, family planning, etc. Efforts will be made to enhance the capacity of forecasting and early-warning of and responding to major diseases as well as public health emergencies; proactively promote the application of methods and techniques of disease prevention and care with TCM; implement the compensation policy for staff working on high-risk post in infectious disease hospitals, plague-contr ol institutions, schistosomiasis-control institutions and other disease prevention and control institutions.(xvi) Ensuring funding for public health services The government will provide fully from the budget the costs of specialized public health institutions re lated to staffing, development and construction, general administration expenses and business operation, and the service revenue of these institutions shall b e turned over to a special fiscal account or integrated into budget management. Free basic public health services shall be provided to urban and rural residen ts item by item. Funding standard for basic public health services will be increased. In 2009, the average per capita public health funding shall be no less th an 15u an, and no less than 20 Y u an by 2011. The central government will grant subsidies to the regions with financial difficulties through transfer payme nts.□□□□□□□□r□□rd □□□□□□r□□□□□□□□r □□□□□□□□□□□□□□ r□□□r□□□□□□□□□□□r□□□□□□□□□□□□□□□□□□□□□□□□□□□r□□□□□□□d □□□□r□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□r□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□r□□□d □r□□□d□□□□□□□□□□□□□□□□□□□□d □d□□□□□□□□□□□-□r□□□□□d □□□r□□□□□□□□□□□□□□r□□□□□□□r□□□□□□r□□□d □□□□□□□□□□□□□□□r□□□□□□□□□□□□□□□r□□□□□□□□□□r□□□□□□□□□r□□□□□□□□□□□□□□□d □□□□□□□□□□□□□□□□□□□□□d □□□□r□□□□□□□□□r□□□□□□d□□□□□□r□□□□□□□d □□□□□□□□□□□r□□□□□□□□□□ r□□□□□□□□□□□□□□□□□d r□□□□□□□□□□□□□□□□□□□□□□□□□□□r□□□d □□□□□□r□□□□□□d □□ d□□□□□d□□□□□□r□□r□□□□□□□r□□□□□□□r□□□□r□□□□□□□□□□□□□□□□□d □□□□□r□□□d□□□□ r□□□r□□□□□□□□□□□ r□□□□r□□□□□□□□□□□□□d □□□□rr□□d □□□□□□□□□□□□□□□□□□r□□□r□□□□r □□□□□□□□□□□d □□□□□□□□□□□□□□□□□□□□r□□□d□□□□□□□□□□ d□□□r□□□□□□□□r □□□□□□□□□□□r□□□□□□□□□r□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□r □□□□□□□□r□□□r□□r□□□□d □□□□□□□□□□□□□□□□□r□□r□□□□□-□□□□d □□□□r□□□□□□□□□□□□□□□d□rd□□□d □r□□□□□□□□□□□□□□r r□□□d□□□□□□□□□□□□□□□□□□d □□□□□□□□□□□□d□□□□□□□□□□r□□□□□□□r□□□□□□r□□□d □□□□□□□r□□□□□□□□□□□□□□□-□□□□□r□□□□□□□□□□d□□□d□□□□□r□□□□□d □r□□□□□□□□□r□□□□□□□□□□□□□□□□□□□□□□□□r□□□r□□□□□□□□□□□□□□□□d □□□□r□□□□□□□□d□□□□□□□□r□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□□ d□□□□□□□□□□r□□□□□□□□□□d□□□□□□□□□□d □□□□□□□□□□□□□□□□□r□□□□□□□□□□□□d□□□□□□□□□□□□□□□□□□□d □□ r□□□□□□□d□□r□□r□□□□□□□□□□□□□□□□□□□□□□□□□□d□□□□□□□□d □□□r□□r□□□□□□□□□□□□□□□□d □□□□□□□□□□□□□□□□□□ r□□□□□□□□□□□□□□□□□□□□□□ r□□□□□□□□□□□□□□□□□□□r□□□□□□□□□□□□□□□□□□□□□□□□□□□□Efforts will be made to explore and establish the public hospital quality regulation and assessment system with the joint participation of government health departments, medical insurance institutions, social assessment institutions, representatives of the public and experts. Strict hospital budget and expenditure and revenue management should be exercised and costing and cost-control strengthened. H o spital information disclosure should be universally implemented for public monitoring.(xviii) romoting the reform on the compensation mechanism of public hospitals Efforts will be made to gradually transform the three compensation c hannels of public hospitals, namely service charges, revenue from drug price margin and fiscal subsidy, to two channels, i.e. service charges and fiscal subsi dy. The government shall support public hospitals for basic construction and large-sized equipment procurement, development of key research subjects, cos ts for retirees in conformity with state regulations, and compensation for policy-related losses, etc.; grant special subsidies to public health services delivere d by public hospitals; ensure funding for public services designated by the government, such as emergency rescue and treatment, foreign aid, assistance to r ural and border areas; offer preferential investment policy to TCM hospitals (including ethnic minority hospitals), women and children’s hospitals, and hos pitals specialized in prevention and treatment of communicable diseases, occupational diseases, mental disorders, etc. The construction scale, standards and loan-taking behaviors of public hospitals should be strictly controlled. The separation of health care services and drug sale should be promoted, gradually re scinding the drug price margin, and banning the acceptance of any drug procurement discount. The revenue reduction and losses incurred from the reform s hall be resolved through introducing prescription fees, readjusting the charging criteria for some technical service, increasing government investment, and e tc. The prescription fees shall be integrated into the reimbursement scope of the basic medical insurance. Efforts will be made to actively explore various ef fective means of separating health care services and drug sale, appropriately increase the price for health care technical services, lowering the price of drug s, medical consumables and examination by large-sized equipment, and conduct regular costing of health care services and sound assessment of the efficien cy of health care services.The special-needs services offered by public hospitals shall be no higher than 10% of the total health care services provided. L o cal governments are encour aged to explore and establish the mechanism for pricing health care services through the consultation of all stakeholders.(xix) ccelerating the formation of a health care structure featuring multiple hospital sponsors The provincial health department shall specify, in con junction with the departments concerned and in light of regional health planning, the quantity, layout, number of hospital beds, allocation of large-sized equ ipment, and major functions of public hospitals within the provincial jurisdiction. Efforts will be made to actively and steadily transform some public hospit als to non-public institutions, formulate the structural reform policy measures for public hospitals, and ensure that the value of state-owned assets be mainta ined and the legal rights and interests of employees safeguarded.Non-public investors are encouraged to sponsor non-profit hospitals. Non-public hospitals are entitled to the same treatment with their public-owned counte rparts in terms of designation of medical insurance eligible institutions, approval of research projects, professional titles assessment and continued educatio n, and both types of hospitals shall be treated equally in terms of service access and supervision. The preferential taxation policies for non-profit hospitals s hall be implemented, and the taxation policy for for-profit hospitals shall be improved.The pilot projects for public hospital reform will be launched in 2009, and popularized in 2011.□□□□□□□□□□rd□□□□□□□□r□□(xx) einforcing organi ation and leadership The State Council will form a leading group on deepening the health care system reform to organize and c oordinate the reform work. The relevant ministries under the State Council should waste no time in formulating relevant supporting documents. G o vernments at various levels, should strengthen leadership, organization and implementation, and accelerate the progress of the priority reform programs.(xxi) ntensifying financial support o vernments at various levels should conscientiously implement the health investment policies of the Opinions, read just the expenditure structure, transform the investment mechanism, reform the compensation methods, ensure funding for the reform, and increase the bene。
美国“新医改”评析
美国“新医改”评析作者：应丽来源：《时代金融》2012年第36期【摘要】医药卫生体制改革是一项重大的民生工程，对改善民生、扩大内需、促进经济社会平稳较快发展等具有重大的现实意义。
美国积极推出医疗保险改革，力求建立政府主导的全民医保制度。
本文从美国医改背景出发进行分析，阐述美国医改方案的主要内容，并从医改的主要影响主体角度对美国医改进行分析评价。
【关键词】医药卫生体制改革美国医改全民医保一、美国医改背景（一）医疗费用高，参保比例低：美国医疗费用高昂，据2000年世界卫生组织统计，美国人均医疗费用支出水平在所有的OECD成员国中居第一位。
从2000年到2008年个人卫生支出增长了60%，卫生总费用占美国GDP的15.2%，在2015年预计将达到20%，远远高于世界上其他发达国家。
美国是世界上唯一没有建立全民医疗体系的发达国家，近年来，美国政府每年投入医保资金高达2万亿美元，占国内生产总值的16%，但美国仍有近5000万人没有医疗保险，约占总人口的19%。
（二）美国经济状况：全球金融危机导致美国经济大萧条，2009年美国国内生产总值增长率为-2.4%。
美国失业率不断上涨、家庭收入减少，越来越多的人无法承担高昂的医保费用，造成缺乏医保的人数逐渐增多，不利于社会稳定发展。
2000年基于雇主的医疗保险占67.1%，而2009年则下降到55.8%。
金融危机背景下，企业经济效益低、财政压力大，不少企业因经营亏损而破产。
有专家认为，导致美国企业大量破产的主要原因不是金融危机，而是高比例的医疗保险费用，使企业因财务压力较大而最终破产。
（三）医改民心所向：尽管美国在医疗保健方面花费大量资金，但保健质量常落后于其他发达国家，患者对医疗服务满意度较低，由于医疗事故，每年有4.6万到9.8万患者死于非命。
大多数美国民众都对美国医疗保健系统提出质疑。
据调查显示，只有40%的美国消费者对美国医疗保健满意，而澳大利亚消费者为73%，丹麦为91%，大部分美国民众认为医疗保健应该完全改革。
中英文对照版__医改意见
Opinions of the CPC Central Committee and the State Council on Deepening theHealth Care System Reform中共中央国务院关于深化医药卫生体制改革的意见In the spirit of the 17th CPC National Congress, for the purpose of establishing a health care system with Chinese characteristics, of gradually realizing the goal that everyone is entitled to basic health care services, and of raising the health level of the Chinese people, we hereby put forward the following opinions on deepening the health care system reform.按照党的十七大精神，为建立中国特色医药卫生体制，逐步实现人人享有基本医疗卫生服务的目标，提高全民健康水平，现就深化医药卫生体制改革提出如下意见。
I. Fully recognizing the importance, urgency and arduousness of deepening the health care system reform一、充分认识深化医药卫生体制改革的重要性、紧迫性和艰巨性The health care sector is a major livelihood issue, as it is closely related to the health of billions of people and the happiness of every household. To deepen the health care system reform, quicken the development of health care sector, meet the people’s ever increasing health care demands, and continuously improve the people’s health is an inevitable requirement of implementing the Scientific Outlook on Development and accelerating economic and social development in a coordinated and sustainable manner, an important measure to maintain social fairness and justice and improve the quality of people’s life, and also a major task of building moderately prosperous society in an all-round way and constructing harmonious socialist society.医药卫生事业关系亿万人民的健康，关系千家万户的幸福，是重大民生问题。
UnitedStatesObamacare美国奥巴马医改
United States Obamacare 美国奥巴马医改Experimental medicine 实验医学A year after the big launch, is Obamacare working? 实施一年的奥巴马医改到底奏效吗？TEXAS has a higher share of uninsured citizens than any state in America. 堪萨斯州未参与医疗保险的人数比美国其他任一州都多。
Until recently Shane, a 38-year-old from Houston, was one of them. 直到近期来自休斯顿38岁的谢恩才刚刚参保。
I just couldn't afford it, he says. 他说，我只是无法负担医疗保险费。
Shane has HIV; his job does not cover him. 谢恩是艾滋病患者，他的工作薪金无法负担他的医药费。
Because of his illness, insurers would offer him only a costly plan with limited benefits. 由于他的疾病，保险公司只愿意提供有限福利但保费昂贵的保险方案。
Such discrimination is now illegal. 但是现在，这样的歧视是非法的。
Since January the Affordable Care Act, better known as Obamacare, has required insurers to charge the healthy and the sick the same price. 自今年一月平价医疗法案，即人们熟知的奥巴马医改要求保险公司向患病及健康的投保人收取同样的保费。
For the first time in 20 years, Shane can afford health cover. 这是20年来首次谢恩能够支付得起他的医疗费用。
美国医改相关论文中英文
Clinical Therapeutics/Volume 35, Number 4, 2013Editor-in-Chief’s NoteHealth Care ReformHealth care and health policy continue to be controversial domestic issues in the United States. Despite a slowingin the rate of growth of annual costs, most Americans feel that their budgets are strained by what they have to payfor health care, and most employers feel that their share of these costs for their employees is excessive. Currently, many Americans still do not have health care coverage. In an effort to remedy such concerns, a series of laws wereenacted in recent years. The first of these, the American Recovery and Reinvestment Act, was signed into law byPresident Obama in 2009. In 2010, after considerable conflict and disagreement, the Preservation of Access to Carefor Medicare Beneficiaries and Pension Relief Act became law. Also in 2010, the Patient Protection and AffordableCare Act and the Health Care and Education Reconciliation Act were signed into law. Although these new laws (taken together, they are often called Obamacare) should have a positive and beneficial impact on the health careof most Americans, there will be many challenges to these efforts as their provisions are phased in over the nextseveral years.Before we can have meaningful reforms, we must make improvements in our study designs and assessmentinstruments. Comparative effectiveness research (CER) is considered by many to be a key component of reform. However, there are limitations to analyses that use secondary databases and nonrandomized, controlled studies. Furthermore, how variables such as adherence, duration of exposure, and definitions, as well as types of outcomes, are handled can substantially affect the validity of CER. The articles by Campbell et al and Cohen in this issue arethoughtful commentaries on CER. These are among a collection of very scholarly reports in this issue assembled byour Topic Editor for Pharmacoeconomics and Health Policy, Denys T. Lau, PhD.We are pleased to be one of a select group of journals who are publishing the Consolidated Health EconomicEvaluation Reporting Standards (CHEERS) statement by Don Husereau, BScPharm, MSc, and colleagues. Thisvaluable document is intended as a guide for future researchers.Finally, we must consider all of the areas not addressed by health care reform. Here arewe have stricter bicycle helmet laws? Will weever have realistic shelf-life regulations for medicines? How can we reduce the number of accidental gun-relatedinjuries? Will we ever have electronic medical record systems that can bridge across institutions and practices? Iinvite any of our readers who have solutions to these and other unaccounted for costs to the health care system tosubmit letters to the editor.Richard I. Shader,MDEditor-in-Chief REFERENCES1.Shader RI. Good news and disappointing news: a new era in health care delivery. J ClinPsychopharmacol. 2010;30:223–224.2. Shader RI. The cart before the horse?Health insurance reform before health care reform.J ClinPsychopharmacol. 2009;29:413–414翻译：临床治疗/35卷，第4期，2013首席编辑的注解医疗改革医疗保健和卫生政策在美国国内仍然是争议的问题。
中美医改方案比较研究(全文)
中美医改方案比较研究(全文)一、中国医改的内容――四项改革(1)理念创新：基本医疗卫生制度成为公共产品。
以前“看病难、看病贵”成为困扰城乡居民的社会问题。
新医改方案则体现了公益性。
包括最低收入阶层的全民，将享有基本医疗卫生服务的基本权利，也标志着政府职能向服务型政府的转变。
(2)全民医保：缓解“看病贵”顽疾的良药。
中国将逐步建立覆盖全民的基本医疗保障制度，首次实现医保的全覆盖。
建立覆盖全民的医保制度，目的在于实现医药费用的合理分担，这是解决老百姓“看病贵”最核心的措施。
(3)服务均等：首次确立基本公共卫生服务均等化目标。
新医改规定城乡居民享受统一卫生服务。
(4)医药分开：建立基本药物制度遏制虚高药价。
实施基本药物制度，对医保药物将实行统一招标、配送，将规范药品流通，遏制虚高药价。
增设药事服务费，推行医药分开。
二、美国医改流程分析(1)扩大医疗保险覆盖面。
政府扩大Medicaid和SCHIP计划，强制大中型企业必须给职工购买医疗保险，对小企业提供职工医疗保险补助。
实现全国保险交换，允许民众可以从国有和私有公司中自由转换或购买保险。
(2)降低成本，提高效率。
推广标准化的电子医疗信息系统，减少医疗保健成本。
确保医疗机构为患者提供尽可能好的医疗服务，包括预防和慢性病管理服务。
改革市场结构以促进竞争。
(3)提高税收，增加政府收入。
奥巴马医改准备金的一半将来自于税收的增加：一是奥巴马在预算案中要求国会提高富裕人群的所得税，将这部分政府收入用于医疗保健领域改革，确保更多低收入人群享受到相关服务。
二是奥巴马还打算对企业实行“排污超标购买制”。
医疗改革的另一部分资金将来自于提高效率，降低成本产生的结余。
三、中美医改方案对比分析中美两国的医疗卫生领域在以下几个方面存在共同缺陷：人口基数大，贫富分化急剧，支付不起医疗费用的人越来越多；医疗卫生领域的支出日益增多，但政府在该领域的支出不足；医疗效率低下。
以下就医改方案实施后中美两国的医保流程进行对比分析：1.医保资金的来源。
中英医疗制度对比 英文版
盛雪20110100137 Comparison of Healthcare System between the UK and ChinaIn Britain’s healthcare system, National Health Service(NHS) is so significant a existence to be ignored. It you happen to have watched the open ceremony of 2012 London Olympics, you may still remember one splendid performance, which aims to pay tribute to those nurses from NHS who have been working hard for the nation’s health since 1944. As regards China, a nation with a much harder life, its healthcare system is not that mature or excellent. But the whole nation have witnessed China’s progress in modifying its medical-care system. The New Rural Cooperative Medical Care System, as a 2005 initiative to overhaul the healthcare system, is a strong evidence for China’s good job in promoting its medical care system. I will compare the healthcare system in the UK and China in three aspects as follows: operating ideas, operating patterns and challenges.Operating ideas:Britain: NHS’s core idea is to provide universal healthcare to all the legal residents in UK. It is primarily funded through the general taxation system. And it is believed in Britain that healthcare system shall be comprised of three sub-systems: local primary service, regional treatment service and central hospital service.China: Cooperative Medical System (CMS) is established to offer basic medical security for all the workers both in cities and in towns. Medical expenditure of each individual is shared proportionally by the country, enterprise and the employee himself. Besides How much the employee would benefit from the system depends properly on how much he contributes to the nation. Furthermore, it is required in China that local administrations, enterprises and agencies shall anticipate in local Social Medical Insurance, to standardize the amount of money people shall pay and help implement related policies.Comparison: Three major differences can be concluded from their operating ideas. Compared with the ideas of China, Britain’s vision has a wider coverage. NHSmanages to serve all the people in the UK, including farmers, people without ability to work as well as disadvantaged groups, some of which are neglected by China’s healthcare system. Secondly, NHS has various medical services, like primary care, in-patient care, long-term healthcare, ophthalmology, and dentistry. As to china, only basic medical insurance is available instead of actual treatment services. At last, funding for each system is obvious not alike, which will be discussed further.Operating patterns:Britain: NHS consists of organizations at all levels: public hospitals, all sorts of clinics, Community Medical Center and Nursing Home etc. These organizations work for British people, concerning with daily medical services, with both the consultation and reservation fee not required. More specifically, everybody in Britain can register with a local GP, namely General Practitioner, who is well-trained in medical and can give advice and treat basic illnesses. GPs are paid by the government according to how many their patients they have. Their services come free of charge.In Britain, Social Security Tax, as an income for government, is levied exclusively for NHS. 82% of NHS funding comes from government fiscal allocation, 12% from National Insurance contributions. Other less significant sources of income include charging overseas visitors and their insurers for the cost of NHS treatment, charges to patients for prescriptions and dental treatment, hospital car parking, patient telephone services, etc.China:The Basic Medical Insurance Fund is implemented by the combination of unified social adjustment and individual account, meantime collected in principle by prefecture-level department. All employers and employees in cites and towns are obliged to pay for the Basic Medical Insurance Fund. At present, the employers will pay for employees’insurance by extracting 6% from employees’salary, and employees pay for themselves by 2%, which will be deposited into individual account. While, the money paid by the employers will be divided into two parts: pooling fund and individual account. Pooling fund has a standard minimum and a cost limitation,mainly functioning for hospitalization expenses and some of the chronic-disease treatment fees. Individual account is responsible for general out-patient expenses. Comparison:People in the UK can receive equal medical care in regardless of people’s social statues or how much money they have. In this respect, British healthcare system is far more fair than China. But, the drawbacks are clear too, in that public sectors operate with a relatively low efficiency. As a result, people often have to wait for a long time to receive treatment. At the same time, medical-care personnel do not get payments equal to their labor, most of the time, which reduces their activity and enthusiasm. China’s way of operating, in some way, avoids these aforementioned problems, but have other big issues: regional imbalance in terms of healthcare development, insurance fund malapportioned so on and so forth.Challenges:Britain: Primarily, To control the funding in an efficient way is very difficult for NHS. Over-supply would produce a heavy burden for the government, which is not good for the sustainability of the system. Funding-deficiency would damage the quality of the services, which would induce complains from citizens. At the moment, UK is quite a scrooge in funding, producing a number of quite expected troubles, such as canceled operations and poor nursing care. Errors by doctors who are either too pressed for time or inadequately funded are also a growing problem. Studies indicate up to 15 percent of all patients in Britain are diagnosed incorrectly or have ailments that are overlooked. Finally, the quality of care is uneven, because local authorities decide which medications or treatments are available.China: What kind of healthcare one would receive relates to his profession, where he was born and what kind of office he is working for: state-owned or private. In my opinion, this is not as fair as Britain. I can’t agree anymore that people shall receive as much as they give. But, in a world everyone is seeking for humanity, wealthy people should pay more and receive the same as the poor. This is a indirect but positive way for the rich to help the poor. I think it is a big challenge for China to minimize theclassifying section in healthcare system. Another big challenge lies in putting-cart before-the-horse phenomenon in the function of administrations and enterprises. Enterprises have to undertake their employees’ healthcare procedures, which should be handled by the administrations. As a result, the development of these enterprises slows down gradually. Last but not least, distribution of healthcare resources is unreasonable, so is cost burden for each person. Thus, remote areas can not enjoy a qualified medical service most of the time.There is no justification to rank these two systems because I am sure that each healthcare system is formulated according to other social patterns, like education, culture, history, laws and so on. But comparing is meaningful because we can learn from each other by doing so. And as long as the government put people’s well-being as the first priority, as long as the government can acknowledge the need to make things better, people in that country would live a happy life, and of course enjoy a better healthcare service.参考文献：∙[英国医保模式对我国医保制度的启示与借鉴] 顾海，鲁翔，左楠- 《世界经济与政治论坛》- 2007年5期。