美国医改相关论文中英文.docx

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 slowing in the rate of growth of annual costs, most Americans feel that their budgets are strained by what they have to pay for 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 were enacted in recent years. The first of these, the American Recovery and Reinvestment Act, was signed into law by President Obama in 2009. In 2010, after considerable conflict and disagreement, the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act became law. Also in 2010, the Patient Protection and Affordable Care 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 care of most Americans, there will be many challenges to these efforts as their provisions are phased in over the next several years.Before we can have meaningful reforms, we must make improvements in our study designs and assessment instruments. 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 are thoughtful commentaries on CER. These are among a collection of very scholarly reports in this issue assembled by our Topic Editor for Pharmacoeconomics and Health Policy, Denys T. Lau, PhD.We are pleased