US and China Health Reform Paths 中美医疗改革之路.ppt
《US and China Health Reform Paths 中美医疗改革之路.ppt》由会员分享,可在线阅读,更多相关《US and China Health Reform Paths 中美医疗改革之路.ppt(26页珍藏版)》请在得力文库 - 分享文档赚钱的网站上搜索。
1、US and China Health Reform Paths中美医疗改革之路,Presented by Jackson Tung, Ph.D.董晓侬博士December 15, 2010,US Health Care Spending美国医疗卫生投入,Total health care spending in 2008 was 2.5 trillion US$ (6.9% increase over 2007).(2008年美国医疗卫生事业投入总额为2万5000亿美金(较2007年增长6.9%)The 2008 figure represented 17% of GDP(占2008年GDP
2、总值的17%)$8,000 per person per year of health care cost.(人均每年医疗卫生费用为8000美金)Health care spending accounted for 10.9 percent of the GDP in Switzerland, 10.7 percent in Germany, 9.7 percent in Canada and 9.5 percent in France. (医疗卫生经费总额占瑞士GDP总额的10.9%,德国GDP总额的10.7%,加拿大GDP总额的9.7%,法国GDP总额的9.5%)According to
3、government analysts, the nations total health care bill by 2015 will be more than $4 trillion, and it will be split about equally between consumers and the government. (据政府分析人士称,国家医疗卫生投入总额至2015年将超过40000亿美金,并把消费者与政府等分开来。),Payer支付方,Service Provider服务提供方,Patient/people患者/人,Three Main Parties in Health
4、Care医疗卫生中的三方主体,Providers服务提供方,Doctors(医生)Hospitals(医院)Laboratories(实验室)Pharmacies(药店)Pharmaceutical Companies (formularies)制药商(处方)Home care and other specialty care(家庭保健和其他专业保健),What Do Providers Do?服务提供者的工作,Family doctors: maintain one-to-one relationship with patients. Mostly through outpatient of
5、fice visits. 家庭医生:与患者保持一对一联系。主要通过门诊看诊。Specialists: provide specialty care. 专科医生:提供专业医治Hospitals: provide inpatient and emergency care. 医院:提供住院服务和急诊。Drug stores: fill drug prescriptions. 药店:提供处方药物Pharmaceutical companies: provide drugs under a “formulary” arrangement with payers. 制药商:与支付方商定后,提供药物。,Pa
6、tient/people(患者/人民),Choose health insurance programs.(选择医疗保险项目)Most programs are associated with employers. (多数项目与雇主合作)People over 65 are covered by Medicare.(超过65岁的公民均享受医疗保险)Consider Medicare supplement insurance.(考虑医疗保险的补贴保险项目)People under a certain poverty line are covered by Medicaid.(在一定贫困线以下的人
7、们享受医疗补助)Enroll annually (with some exceptions). 年度登记(有一些例外)Still left 15% of the population “uninsured.” (还是有15%的人没有保险。),What Do People/Patients Do?人民/患者的工作,Uninsured: seek emergency care or Medicaid(无保险者:寻求急诊治疗或医疗补助)Insured:(有保险者)Choose a family doctor from the list given by payers. 从支付方提供的清单中,选择一位
8、家庭医生。Family doctor becomes the “care manager” for the patient. 家庭医生变成了此位患者的“医疗管理者”。Family doctor must make referral to specialists or hospitals. 家庭医生必须转介专业医师或医院。Make co-pay as defined by payers (office visits, generic / brand name drug, out-of-pocket maximums, etc.) 以支付标准为依据的共付制度(就诊、非专利/品牌药物、现款支付的最高
9、额度及其他),Payers(支付者),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)Indemnity Plans (fee for service) 补偿计划(服务费用)Preferred Provider Organizations (PPO) 优先选择医疗服务 提供者组织(PPO)Staff model HMOs(拥有医院和受薪医师
10、的卫生维护组织)Employer sponsored programs(雇主资助项目)Patients(患者),What Do Payers Do?支付方的工作,Pay claims submitted by providers. 支付服务提供方提交的费用Establish “reasonable and customary” fee schedule. 建立“合理及常规的”收费率表Provider contracting based on price and quality. 以价格和质量为基础,与服务供应方订立合同Manage care through pre-authorization,
11、 referrals, case management, and preventive care. 通过授权、转介案例管理和预防保健,而进行的管理工作。,When Health Insurance Companies Compete People/patient Benefit医疗保险公司的竞争-人/患者利益,What benefits health insurance companies:(对医疗保险公司最有利的事)People stay healthy (prenatal care)人们保持健康(产前保健)Diseases are diagnosed early (mammogram)早期
12、诊断病情(乳房X光照片)Minimize disease complications (diabetes)减少并发症-糖尿病,Health Insurance Companies Keep Provider Costs Down医疗保险公司把服务提供方的费用降到最低,Physician contracting(医生契约)Hospital contracting(医院契约)Pharmaceutical company contracting (formulary)药品制造商契约(处方),This removes all “extra benefits” from providers and al
13、low health insurance companies to, in theory, pass the benefits to consumers.这排除了服务提供方的“额外收益”,而将此利益让渡给医疗保险公司,理论上说,是消费者受益。,A Private Third Party Payer is the key to keep US Health Care System in Balance 私营的第三支付方是平衡美国医疗卫生体系的关键,Payer支付方,Service Provider服务提供方,Patient/people患者/人,Three Main Parties in Hea
14、lth Care医疗卫生中的三方主体,Competition after Privatization私营下的竞争,Providers must compete for Payer business.(为争取支付方,服务提供方间的竞争)Payers must compete for Patient business.(为争取患者,支付方间的竞争)Each market must have multiple Payers (A, B, and C insurance companies)(每一市场必须有多个支付者-ABC保险公司)Each market must have multiple Pro
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- us and china health reform paths 中美 医疗 改革
限制150内