新加坡如何做到低价优质的医疗服务？（四）

今天我们就读完了医疗制度为主题的这篇文章。

前面我们先看到了新加坡在实施的制度，后面主要是美国医疗制度的问题，以及和新加坡医疗制度的对比和如何改革美国医疗制度。

本文出自《财富》杂志，文章主要以肖恩·马萨基·弗林在书籍《The Cure That Works 》中提出的内容，总结了美国医疗制度现存的问题。

我们一起来看这剩下的最好一部分。

后续发现有意思的医疗相关的文章会在分享给大家，感谢阅读。

加大拿、英国、法国和其他国家的单一支付制度怎么样呢？

弗林直白地展示了他们是如何控制开支的：通过限额配给。患者需要等很久才等到专科医师而根据年龄和状况进行治疗，也或许根本得不到治疗。自由市场卫生保健方法在美国行得通吗？当然。

已经在使用的两个例子是选择性整容手术以及镭射视力矫正手术，这两项都不包括在医保里。尽管如此，对这两项手术的需求都大幅上升。结果呢？在过去20年里，手术效果得到提升，受通胀影响，镭射视力矫正手术价格下降仅50%，整容手术下降25%。

印第安纳州提供了另一个例子。

回到2007年，其为州员工提供了一种高免赔额的健康储蓄账户（HSA）选择。免赔额是2750美元，印第安纳州每年都把这笔钱存入员工的HSA，成为员工的个人财产。超出免赔额的部分，员工需要支付20%，可高达8000美元；超出部分全由保险公司支付。

因此，一年的自付费用总额上限为1000美元多一点。

参与该计划的员工减少了35%的支出，因为他们突然有了让医疗费用有价值的动力，比如选择仿制药而非更加昂贵的品牌药以及去急性治疗诊所看病，而不是急着去昂贵的医院急诊室。弗林无可辩驳的底线：我们应该大力推行HSAs这种高免赔额健康保险政策，由雇主支付免赔额，且医疗提供方要公布一切开支的价格。

进行这种深刻变革的条件或许已经成熟。雇主们已经在争取高免赔额的政策，但许多人并没有把它们纳入到强有力的HSAs中。此外，不必要的限制使HSAs的实施并不顺利，比如禁止使用HSAs购买非处方药。

首先，华盛顿应该要求保险公司在提供传统保险的基础上再提供这样的保险，并且应该取消那些HSA的限制。

此外，印第安纳州也为其医疗补助计划成功开创了一种新加坡式的方法。

What about single-payer systems such as those in Canada, the U.K., France and elsewhere?

Flynn bluntly shows how they control expenses: by rationing. You wait and wait to visit a specialist and,depending on your age and condition, you may not be treated at all.

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Could a free-market health-care approach work in the U.S.? Of course.

Two examples where this is already being used are elective cosmetic surgeries and LASIK eye surgeries, which aren't covered by insurance.Nonetheless, demand for both has zoomed. Results? Outcomes have improved, and prices, adjusted for inflation,have dropped by almost 50% for LASIK operations and 25% for cosmetic procedures over the past 20 years.

The state of Indiana provides another example.

Back in 2007 it offered state employees the option of taking a high-deductible policy with a health savings account (HSA).

The deductible was $2,750, with Indiana putting that amount each year into the employee's HSA,which became the employee's personal property. The worker would pay 20% of costs above that, up to $8,000; anything above that was covered 100%.

The total out-of-pocket expense in a year was thus capped at a bit more than $1,000.

Employees in this plan reduced their spending 35%, because they suddenly had an incentive to get value for their health-care dollars,such as choosing generic drugs over the more expensive brand names and visiting acute-care clinics instead of rushing to a more costly hospital emergency room.

Flynn's irrefutable bottom line: We should vigorously pursue high-deductible health insurance policies with HSAs that would cover the deductible and be paid for by the employer, combined with posted prices for everything offered by providers.

Conditions may be ripe for such a profound change. Employers are already going for high-deductible policies,but many are not attaching them to robust HSAs. In addition, HSAs are hobbled by unnecessary restrictions,such as a ban on using them for over-the-counter medicines.

As a start, Washington should require insurers to offer such policies in addition to their traditional ones and should remove those HSA constraints.

By the way, Indiana is also successfully pioneering a Singapore-like approach for its Medicaid program.