[雙語翻譯]醫(yī)療改革外文翻譯--歐洲的醫(yī)療改革和降低成本的策略

1、8500 英文單詞， 英文單詞，4.9 萬英文字符，中文 萬英文字符，中文 15800 字文獻(xiàn)出處： 文獻(xiàn)出處：Simonet D . Healthcare reforms and cost reduction strategies in Europe: The cases of Germany, UK, Switzerland, Italy and France[J]. International Journal of Health

2、Care Quality Assurance, 2010, 23(5):470-88.Healthcare reforms and cost reduction strategies in EuropeThe cases of Germany, UK, Switzerland, Italy and FranceDaniel SimonetAbstractPurpose – This paper aims to analyse healt

3、h reforms carried out in a sample of European countries. Design/methodology/approach – Using a country-specific approach, outstanding health reform features such as: greater competition between sickness funds in Germany;

4、 fund-holding practices in the UK; managed care models in Switzerland; health networks in France; and healthcare system decentralisation in Italy are analysed.Finding – There have been different approaches to controlling

5、 healthcare costs. Some states relied on public sector competition by creating quasi-markets (UK), insurance sector competition, particularly in Switzerland and Germany, organisational reforms in France by creating healt

6、h networks and decentralisation in Italy.Research limitations/implications – Societal and legal aspects are not discussed. Originality/value – The paper compares healthcare reform effectiveness in a number of western

7、 European countries.Keywords: Health services, Public sector reform, European UnionIntroductionAlthough the Bismarck and Beveridge doctrines inspired European health systems, both clashed during the second half of the tw

8、entieth century. The Bismarck model dates back to 1880 and covers the working population (for accidents, diseases, disability and retirement). Three laws:·1883 (sickness insurance);·1884 (work injury insurance

9、), which later became the statutory industrial accident insurance; and·1889 (disability and elderly care), which became the statutory pension insurance, laid down its foundations.The Bismarck doctrine was based on p

10、aid work. Social security benefits were only granted to those who worked; health services and financial contribution depended on income level. Unemployed and pensioners, on the other hand, were excluded from the system.

11、Nevertheless, it offered a generous protection to workers; for example, the first industrial laws held firms responsible for work injuries. Its influence was great in Italy, France and Sweden.Beveridge (Churchill’s Healt

12、h Minister) model is a more recent and liberal doctrine. It was developed in a working paper compiled in Great Britain and diffused in 1942 under the title Social Insurance and Allied Services that came into effect in 19

13、48. It imposed universal coverage (which differs from the Bismarck model because it was not restricted to salaried workers). Beveridge was funded through taxation and also responded to many other non-health concerns (e.g

14、. integrating the former East Germany, generated additional expenditure.The healthcare system was partially liberalised after adopting the Seehofer reform. The 1992 version led to a switch from a per-bed, per-day payment

15、 to global budgeting. It included other drastic measures such as suppressing hospital beds and greater physician-practice regulations. In 1993, fixed budgets were attributed to each hospital and managers were free to use

16、 budget surpluses. In 1996, flexible budgets were adopted, and included per diem payments and payment per cases adjusted to take into consideration local population characteristics. Target budgets were added: if spending

17、 goes beyond a certain cap defined by a global budget then both hospital and insurer must cover the excess. In 1996, competition between insurers was instilled into the system, which led to equalising patient premiums. T

18、he reform instituted choice, which can be terminated by the insured, has compensation mechanisms aimed at preserving equity and access to care for all. Competition also stimulated insurer concentration and aimed at impro

19、ving public insurer competitiveness against private insurers. However, none of these mechanisms was original. In 1986, The Netherlands adopted the Dekker reform leading to more competition between insurers and freedom of

20、 choice for the insured. The difference with the German model was the priority given to health networks. To this were added other measures to foster ambulatory surgery, residential care services, prescribing generic drug

21、s and formulating a German health network (i.e. Das Deutsche Gesundheitsnetz). Authorities regulated medical staffing because physician and equipment density were already high, and experimented with physician networks in

22、 Berlin. These were close to Switzerland’s gate keeping experiments (Himmel et al., 2000; Ratajcak, 1998). Though health expenditure stabilised, there were occasional deficits (nearly 20 billion Marks in 1995). Lastly, t

23、he system was poorly coordinated; there were occasional conflicts between social security system and hospitals.In July 2001, Werner Muller, then Economy Minister, proposed insurance capitalisation to replace traditional

24、insurers. Employers’ insurance contribution was then paid directly to the employee who would choose any private insurance. The contribution to the sickness fund would be equally shared by employee and employer; this newl

25、y-proposed insurance also aimed to stabilise or reduce employer contribution to sickness funds (which can reach up to 15 per cent of the gross salary). Unlike Switzerland where fees vary across cantons, German premiums v

26、aried across sickness funds, and another reform objective was to reduce variations. However, many healthcare players (e.g. public insurers) were hostile to the reform.Decentralisation had been on the agenda before taking

27、 the opposite direction in the 1990s. With the federal government seeking to reduce its involvement in healthcare management, regions (i.e. Landers) were to manage hospitals economically: Landers are in charge of plannin

28、g and financing new hospital buildings and other large investments while statutory health insurance companies pay for most hospital operating costs. But decentralisation is neither a cost-containment measure per se nor s

29、hared by all nations in our sample: the Swiss healthcare system “became more centralised and nationally uniform” after the federal Health Insurance Law (Krankenversiche-rungsgesetz) was adopted in 1994, which took effect

30、 in 1996 (Reinhardt Uwe, 2004). With more than 1,000 different sickness funds in the early 1990s (reduced to less than 500 in 1998), the German system was pluralistic with private, social (not for profit) and public comp

31、onents rather than a dichotomous public/private system: there are different private providers for outpatient care and public, social and private providers for inpatient care: influential stakeholders are one of the Germa