|
市場調查報告書
全民保險的發展道路：美國的動向
Paving the Difficult Road to Universal Insurance Coverage: Spotlight on U.S. Innovators
|
本報告已在2011年12月21日停止出版。
美國全民保險制度的確立正成為熱烈討論的議題。目前未加入保險的4,700萬美國正熱烈討論這個保險制度案的議題。
本報告書內容包括：麻薩諸塞州、緬因州、佛蒙特州的保險制度、國家水準的全民保險議題、未來預測等。內容綱要摘記如下：
實施概要
有關新的急迫性的老舊議題
麻薩諸塞州提供了模式
- 州的醫療保險加入者
- 最低水準已確立的保險制度的定義
- 保險費支付能力的定義
- 州的保險制度計畫
- Medicaid的發展及復甦
- 州的選擇性醫療保險計畫
- 強制加入
- 雇用者的責任
- 從麻薩諸塞州的經驗獲得的啟示：其他改革的影響
- 未來的課題
- 溝通
- 保險費用的未付能力
- 初級照護人員不足
- 雇用者的課題
- 可持續性及降低費用策略
緬因州及佛蒙特州：其他先驅者
- 緬因州
- DirigoChoice
- 降低費用改革
- Maine Quality Forum
- 從緬因州的經驗獲得的啟示：其他改革的影響
- 未來的課題
- 佛蒙特州
- Catamount Health Insurance Plan
- 雇用者的責任
- 慢性病照護動機
- 從佛蒙特州的經驗獲得的啟示：其他改革的影響
- 未來的課題
國家整體的解決方案：國家水準的全民保險方案
- 布希政權的稅制改革案
- 布希改革案的詳細內容
- 布希改革案的問題
- 國内討論開始
- 議會中的全民保險法案
- 面對全體國民的Medicare
- Healthy Americans Act
- 州／國家的合作
未來預測
- 州／國家合作的重要性
- 州主導的陷阱
- 主要問題：因應費用問題
- 管理目前的成本及抑制擴大支出
- 藥價標的
- 患者費用負擔增加
- 漫長道路
Abstract
Introduction
The controversial issue of establishing universal health insurance has
recently reclaimed the spotlight in the United States. Various states, members
of Congress, President George W. Bush, and 2008 presidential hopefuls are
proposing plans to make health insurance more accessible to the approximately
47 million U.S. residents who do not have coverage.
Get the Answers You Need to Shape Your Strategy
- Massachusetts, Maine, and Vermont are leading the way in expanding
universal health care coverage. How have these states achieved consensus on
such a hot button issue? What are the key elements of these state health care
plans? What are the implications for other reform efforts?
- Other states have expressed considerable interest in Massachusetts'
groundbreaking universal coverage plan. Which states have viable programs on
the horizon? What have they learned from the Massachusetts planning and
implementation process that will help them develop their own successful new
universal coverage plans?
- As this fl urry of state health reform activity continues, proposals at
the federal level aim to complement state efforts or to set in motion sweeping
national reform. Which initiatives have gained national support? Which of the
universal coverage bills in Congress target drug pricing?
- Universal coverage proposals may threaten to take greater control over
drug prices. Would new initiatives give states the power to negotiate drug
prices with manufacturers? Are proposals requiring drug-price negotiation
likely to garner much support in the near future?
Scope
- Massachusetts: leading the way. Details on passage and implementation of
the plan, the mandate for individual coverage, employer responsibilities,
implications for other reform efforts, and future challenges.
- Maine: at the forefront of universal coverage. DirigoChoice plan details,
cost-containment reforms, Maine Quality Forum, implications for other reform
efforts, and future challenges.
- Vermont: implementation looming. Catamount Health plan details, employer
responsibilities, chronic care initiatives, implications for other reform
efforts, and future challenges.
- National solutions: universal coverage at the federal level. The Bush
administration proposal, Medicare for All, Healthy Americans Act, and
state/federal partnerships.
- Future perspectives: promise and problems. Value of compromise and
cooperation, potential pitfalls for state initiatives, cost-control issues,
and drug pricing.
Table of Contents
- Executive Summary
- Strategic Considerations
- Stakeholder Implications
- An Old Debate Takes on New Urgency
- Massachusetts Provides a Model
- Commonwealth Health Insurance Connector
- Defi ning Minimal Creditable Coverage
- Defi ning Affordability
- Commonwealth Care Health Insurance Program
- Medicaid Expansions and Restorations
- Commonwealth Choice Health Insurance Program
- Mandating Coverage for All
- Employer Responsibilities
- Learning from the Massachusetts Experience: Implications for Other
Reform Efforts
- Future Challenges
- Communication
- Affordability
- Primary Care Provider Shortage
- Employer Challenges
- Sustainability and Cost-Containment
- Maine and Vermont: Other Innovators at the Forefront
- Maine
- DirigoChoice
- Cost-Containment Reforms
- Maine Quality Forum
- Learning from the Maine Experience: Implications for Other Reform
Efforts
- Future Challenges for Maine
- Vermont
- Catamount Health Insurance Plan
- Employer Responsibilities
- Chronic Care Initiatives
- Learning from the Vermont Experience: Implications for Other Reform
Efforts
- Future Challenges for Vermont
- In Search of a National Solution: Universal Coverage Proposals at the
Federal Level
- Bush Administration Tax Reform Proposal
- Details of the Bush Proposal
- Problems with the Bush Proposal
- Starting a National Discussion
- Universal Coverage Bills in Congress
- Medicare for All
- Healthy Americans Act
- State/Federal Partnerships
- Future Perspectives
- Importance of Federal/State Partnerships
- Potential Pitfalls for State Initiatives
- A Key Issue: Addressing Costs
- Controlling Current Costs and Spending Growth
- Targeting Drug Prices
- Increasing Patient Cost-Sharing
- A Long Road Ahead
Tables
- 1. Health Insurance Coverage of the U.S. Population, 2002-2006
- 2. State Universal Coverage Bills, 2007
- 3. Key Elements of Massachusetts' Health Care Reform
- 4. Affordability Scale for Massachusetts Health Insurance Premiums Based
on Income Level, 2007
- 5. Coverage Options Offered by Commonwealth Choice Plans
- 6. Maine' s DirigoChoice Coverage Plan
- 7. Vermont' s Catamount Coverage Plan
- 8. Comparison of Key Elements of Universal Coverage Proposals at the
Federal Level, 2007
- 9. Key Elements of the Health Partnership Act and Health Partnership
Through Creative Federalism Act
Figures
- 1. 2006 Health Insurance Coverage: United States
- 2. U.S. National Health Expenditures per Capita and Corresponding Share of
Gross Domestic Product, 1960-2007
- 3. Status of State Initiatives for Health Care Reform
- 4. 2006 Health Insurance Coverage: Massachusetts
- 5. 2006 Health Insurance Coverage: Maine
- 6. 2006 Health Insurance Coverage: Vermont
- 7. Key State and Federal Health Insurance Expansion Activities, 2004-2006
- 8. U.S. National Health Expenditures, by Type of Service, 2005
Sidebars
- Ingredients for Health Care Reform: Key Opinion Leader Insights
- Universal Coverage Mandates: Key Opinion Leader Insights
- Factors Affecting the National Movement: Key Opinion Leader Insights
- All Eyes on California as Governor Schwarzenegger Pitches Universal
Coverage Plan
|
