1、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 c
2、ost 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 auto
3、nomy 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
4、 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
5、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 funda
6、mentally 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 auto
7、nomously, 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 have accepted the trade-off of lower fees for a guaranteed flow of patients. The reality is that this new mode
8、l has rapidly emerged as a dominant one in the American health care system. At the same time as these new networks are developing, some existing large multispecialty group practices that previously treated patients only on a traditional fee-for-service basis are offering benefit packages directly to
9、 payers for a prepaid, fixed premium. Medical group practices that now operate such managed care plans, which may generate 30 to 40 percent of the practices total patient revenues, include the Carle Clinic in Urbana, Illinois, the Dean Clinic in Madison, Wisconsin, the Geisinger Clinic in Danville,
10、Pennsylvania, the Marshfield Clinic in Marshfield, Wisconsin, the Ochsner Clinic in New Orleans, the Palo Alto Clinic in Palo Alto, California, the ParkNicollet Clinic in Minneapolis, the Scott and White Clinic in Temple, Texas, and the Virginia Mason Clinic in Seattle. The Cleveland Clinic and many
11、 other hospitals across the country have taken an important step in this direction by offering third parties fixed prices for bundled sets of medical services for example, a fee for all the services (provided by physicians, hospitals, and ancillary personnel) required to perform a coronary-artery by
12、pass operation or a heart or kidney transplantation. The emergence of managed care is the subject of this report my third on the American health care system. It represents the latest stage in a long struggle that has pitted the priorities of practicing physicians against management structures that h
13、ave sought to gain firmer control over what doctors do. The traditional autonomy that physicians have enjoyed as ministers to the sick and as recipients of a state grant of monopoly power in medical practice what Freidson calls professional dominance5 is being threatened by these new arrangements. T
14、he new constraints, along with other economic and social pressures, are encouraging physicians to aggregate in larger professional groups that offer them greater protection against external assaults on their autonomy, as well as more regular working conditions. Most organizations that provide manage
15、d care are called either health maintenance organizations (HMOs) or preferred-provider organizations (PPOs). Within these categories, there are variations on the basic theme, reflecting the fact that the organization of managed care is evolving rapidly. Although still largely a regional phenomenon,
16、far more prevalent on the East and West Coasts and in the Midwest, managed care is clearly a phenomenon that, in one form or another, is here to stay, despite the misgivings of many doctors.7 The states with the largest numbers of people enrolled in HMOs and the highest percentages of their populati
17、on enrolled in such plans are California (33.4 percent), Massachusetts (30.9 percent), Minnesota (28.3 percent), Oregon (26.4 percent), Arizona (24.2 percent), Hawaii (22.9 percent), Wisconsin (22.5 percent), Maryland (22.3 percent), Colorado (21.9 percent), and Connecticut (20.7 percent). Most of t
18、he legislative proposals to reform the health care system, regardless of the ideological stripe of their sponsors, promote expansion of managed care. Private business the community of interests that, if it ever really extended itself on behalf of health care reform, could propel it forward views man
19、aged care as its best current hope to control costs and preserve the dominance of the health system by private providers and payers. Recently, even the American Medical Association, in the form of a speech delivered on June 8 by executive vice-president Dr. James S. Todd, conceded that it has been s
20、low in recognizing and accepting the legitimacy, the benefits, of these modes of practice； Todd acknowledged the positive contributions made by HMOs and other members of the Group Health Association of America. As proposals for managed care evolve, new alliances are formed among major stakeholders s
21、eeking competitive advantage. One of the most interesting recent developments was announced on June 30 in Minneapolis, long a center of managed care. Fourteen Minneapolis-based companies, including Dayton Hudson Corporation, General Mills, Norwest Corporation, and the IDS Financial Corporation, a su
22、bsidiary of American Express, which had sponsored a bidding competition, named a consortium of health institutions to which they will channel their more than 125,000 employees and dependents for their medical care. The consortium includes the Mayo Clinic, the ParkNicollet Medical Clinic, and Group Health, a local HMO. The other finalist was Minnesotas Blue Cross and Blue Shield plan. Although the purchasing
