《中美医改之比较》PPT课件.ppt

* The Health Care Reform Paths of US and China Three Main Parts in Health Care Providers Doctors Hospitals Laboratories Pharmacies（药店） Pharmaceutical Companies (制药商) Home care and other specialty care（家庭保健和其他专业保健） What Do Providers Do? Payers Government: Medicare and state Medicaid programs（政府：医疗保险制度和州级公共医疗补助项目) Health insurance programs / Health Maintenance Organizations (HMO). (医疗保险 项目及卫生维护组织) o Indemnity Plans (fee for service) 补偿计划（服务费用） o Preferred Provider Organizations (PPO) （优先选择医疗服务 提供者组织（PPO） o Staff model HMOs(拥有医院和受薪医师的卫生维护组织） o Employer sponsored programs（雇主资助项目） Patients What Do Payers Do? Then, what should people/patients do? Insured: choose health insurance programs Uninsured: seek emergency care or Medicaid（医疗补助） What is a Reform? Re-alignment of stakeholders and their benefits （利益持有者和利益的重新分割） A good reform makes stakeholders’ interests match peoples’ interests （好的改革使利益持有者的利益与人民的利益吻合） China’s reform effort must have “built-in” anti-corruption component （中国医疗改革须纳入反腐败部分） The reasons: After privatization（私营）, the providers must compete for payer business. The payers must compete for patient business. Competitions on both price and quality. Medicare(医疗保险) Medicaid（医疗补助） Through Medicare and Medicaid, the federal government has become the largest payer. A rise in the number of benefited people. Medicare spending will be more than double in the next decade. The differences between Health Insurance(医疗保险) and National Health Plan(全民医保) Health insurance companies are private business, they usually provide business on their own behalf. National Heath Plan is an entitlement(权益性) program, not subject to above concerns, so it needs lower cost to imple. Obamas timeline of health care reform 2010—2014 People under 26 can be covered by parents. No pre-existing condition or health status for people. Life time/annual limits removed. No policy cancellation after a person gets ill. Citizens pay fine for no insurance. Em