美国医疗保健制度------管理式医疗护理.docVIP

本科毕业设计（论文） 外 文 翻 译 原文 The American Health Care System — Managed Care Americas private and public third-party payers, squeezed by health care costs that continue to soar at rates well above inflation, are persuaded that managed care plans will produce demonstrable savings as compared with the current cost trends of traditional fee-for-service medicine. They are accelerating their efforts to promote plans that integrate the delivery and financing of care and that apply new constraints on encounters between physicians and patients. The key constraint for doctors is the limitation placed on the autonomy of their clinical decisions. The constraint for patients is the requirement that they see only physicians who are members of a plans closed or partially open panel or who are selected as preferred practitioners. In general, these doctors have agreed to deliver only necessary medical services in return for prescribed fees. Most definitions characterize managed care as a system that integrates the financing and delivery of appropriate medical care by means of the following features: contracts with selected physicians and hospitals that furnish a comprehensive set of health care services to enrolled members, usually for a predetermined monthly premium; utilization and quality controls that contracting providers agree to accept; financial incentives for patients to use the providers and facilities associated with the plan; and the assumption of some financial risk by doctors, thus fundamentally altering their role from serving as agent for the patients welfare to balancing the patients needs against the need for cost control — or, as Mechanic put it succinctly, moving from advocacy to allocation. Because these features circumscribe the freedom of physicians to practice medicine autonomously, they receive decidedly mixed reviews from doctors. Nevertheless, at least half of all practicing physicians have become involved in at least one managed care arrangement, and they