美国医改实施的进展、前景与启示

美国医改实施三年来，在扩大医保可及性、改革医疗服务市场、降低医疗费用和改进服务质量方面取得较大进展，但许多触及既得利益集团的核心改革政策如建立保险交易所、改革支付方式、削减部分福利项目、提高富人税率等开源节流措施尚未正式启动，这将成为奥巴马连任后面临的主要挑战。美国医改鼓励服务的整合、改革支付制度、重视预防保健服务等做法值得中国医改借鉴，同时以商业医疗保险为主导的保险体系暴露出的弊端也启示中国政府以更加审慎的态度发展商业医疗保险。

Progress, outlook and implications of U.S. healthcare reform

In the past three years of U. S. health care reform, many progress has been achieved in improving the accessibility of care, health market reform, reducing the health expenditure and improving the quality of health services. However, many key reform policies touching the interests of key stakeholders have not yet started, such as establish the health insurance exchange, reform the payment method, raise funds and reduce the cost of the reform via enhancing tax rates for the rich and cut some health welfare programmes, which will turn out to be the major chal- lenges after Obama＇ s second term. The experience in U.S. reform which encourages the integrated care, payment system reform, strengthening the primary care and so on could be referred to in China health reform, meanwhile, the problems emerged in the private medical insurance dominated health care system also indicate Chinese government should take more prudent attitude in developing commercial medical insurance.