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There have been a number of different health care reforms proposed during the Obama administration. Key reforms address cost and coverage and include obesity, prevention and treatment of chronic conditions, defensive medicine or tort reform, incentives that reward more care instead of better care, redundant payment systems, tax policy, rationing, a shortage of doctors and nurses, intervention vs. hospice, fraud, and use of imaging technology, among others. The first of these reform proposals to be passed by the United States Congress is the Patient Protection and Affordable Care Act, which originated in the Senate and was later passed by the House of Representatives in amended form on March 21, 2010 (with a vote of 219–212).〔Noam N. Levey and Janet Hook, "(House passes historic healthcare overhaul )," ''Los Angeles Times'' (March 22, 2010).〕〔(【引用サイトリンク】title=House sends health care overhaul bill to Obama )〕 President Obama signed the reforms into law on March 23, 2010. Reuters and CNN summarized the reforms and the year in which they take effect. ==Overview== A variety of specific types of reform have been suggested to improve the United States health care system. These range from increased use of health care technology through changing the anti-trust rules governing health insurance companies and tort-reform to rationing of care. Different overall strategies have been suggested as well.〔(New England Journal of Medicine-A Systemic Approach to Containing Healthcare Spending-September 2012 )〕 The Institute of Medicine reported in September 2012 that approximately $750B per year in U.S. healthcare costs are avoidable or wasted. This included: unnecessary services ($210 billion annually); inefficient delivery of care ($130 billion); excess administrative costs ($190 billion); inflated prices ($105 billion); prevention failures ($55 billion), and fraud ($75 billion).〔(Atlantic-Brian Fung-How the U.S. Healthcare System Wastes $750B Annually-September 2012 )〕 During a June 2009 speech, President Barack Obama outlined his strategy for reform. He mentioned electronic record-keeping, preventing expensive conditions, reducing obesity, refocusing doctor incentives from quantity of care to quality, bundling payments for treatment of conditions rather than specific services, better identifying and communicating the most cost-effective treatments, and reducing defensive medicine.〔(【引用サイトリンク】title=Remarks by the President to the AMA-June 15, 2009 )〕 President Obama further described his plan in a September 2009 speech to a joint session of Congress. His plan mentions: deficit neutrality; not allowing insurance companies to discriminate based on pre-existing conditions; capping out of pocket expenses; creation of an insurance exchange for individuals and small businesses; tax credits for individuals and small companies; independent commissions to identify fraud, waste and abuse; and malpractice reform projects, among other topics.〔(【引用サイトリンク】title=Summary of Obama Plan )〕〔(【引用サイトリンク】title=Remarks by the President to a Joint Session of Congress-September 2009 )〕 In November 2009, then-OMB Director Peter Orszag described aspects of the Obama administration's strategy during an interview: "In order to help contain (Medicare and Medicaid ) cost growth over the long term, we need a new health care system that has digitized information...in which that information is used to assess what’s working and what’s not more intelligently, and in which we’re paying for quality rather than quantity while also encouraging prevention and wellness." He also argued for bundling payments and accountable care organizations, which reward doctors for teamwork and patient outcomes.〔(【引用サイトリンク】title=Charlie Rose-Peter Orszag Interview-November 3, 2009 )〕 Mayo Clinic President and CEO Denis Cortese has advocated an overall strategy to guide reform efforts. He argued that the U.S. has an opportunity to redesign its healthcare system and that there is a wide consensus that reform is necessary. He articulated four "pillars" of such a strategy:〔(【引用サイトリンク】title=Denis Cortese Interview on Charlie Rose Show-July 2009 )〕 *Focus on value, which he defined as the ratio of quality of service provided relative to cost; *Pay for and align incentives with value; *Cover everyone; *Establish mechanisms for improving the healthcare service delivery system over the long-term, which is the primary means through which value would be improved. Writing in The New Yorker, surgeon Atul Gawande further distinguished between the delivery system, which refers to how medical services are provided to patients, and the payment system, which refers to how payments for services are processed. He argued that reform of the delivery system is critical to getting costs under control, but that payment system reform (e.g., whether the government or private insurers process payments) is considerably less important yet gathers a disproportionate share of attention. Gawande argued that dramatic improvements and savings in the delivery system will take "at least a decade." He recommended changes that address the over-utilization of healthcare; the refocusing of incentives on value rather than profits; and comparative analysis of the cost of treatment across various healthcare providers to identify best practices. He argued this would be an iterative, empirical process and should be administered by a "national institute for healthcare delivery" to analyze and communicate improvement opportunities. A report published by the Commonwealth Fund in December 2007 examined 15 federal policy options and concluded that, taken together, they had the potential to reduce future increases in health care spending by $1.5 trillion over the next 10 years. These options included increased use of health information technology, research and incentives to improve medical decision making, reduced tobacco use and obesity, reforming the payment of providers to encourage efficiency, limiting the tax federal exemption for health insurance premiums, and reforming several market changes such as resetting the benchmark rates for Medicare Advantage plans and allowing the Department of Health and Human Services to negotiate drug prices. The authors based their modeling on the effect of combining these changes with the implementation of universal coverage. The authors concluded that there are no magic bullets for controlling health care costs, and that a multifaceted approach will be needed to achieve meaningful progress.〔Cathy Schoen, Stuart Guterman, Anthony Shih, Jennifer Lau, Sophie Kasimow, Anne Gauthier, and Karen Davis, ("Bending the Curve: Options for Achieving Savings and Improving Value in the U.S. Health Spending" ) Commonwealth Fund, December 2007〕 During February 2010, President Obama updated his reform proposal, with modifications to the bills that had passed as of that time.〔(【引用サイトリンク】title=President Obama's Plan – February 2010-Whitehouse Website )〕 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Health care reforms proposed during the Obama administration」の詳細全文を読む スポンサード リンク
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