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Health care reform is a general rubric used for discussing major health policy creation or changes—for the most part, governmental policy that affects health care delivery in a given place. Health care reform typically attempts to: * Broaden the population that receives health care coverage through either public sector insurance programs or private sector insurance companies * Expand the array of health care providers consumers may choose among * Improve the access to health care specialists * Improve the quality of health care * Give more care to citizens * Decrease the cost of health care ==United States== (詳細はright to health care, access, fairness, sustainability, quality and amounts spent by government. The mixed public-private health care system in the United States is the most expensive in the world, with health care costing more per person than in any other nation, and a greater portion of gross domestic product (GDP) is spent on it than in any other United Nations member state except for East Timor (Timor-Leste). A study of international health care spending levels in the year 2000, published in the health policy journal ''Health Affairs'', found that while the U.S. spends more on health care than other countries in the Organization for Economic Co-operation and Development (OECD), the use of health care services in the U.S. is below the OECD median by most measures. The authors of the study concluded that the prices paid for health care services are much higher in the U.S.〔Gerard F. Anderson, Uwe E. Reinhardt, Peter S. Hussey and Varduhi Petrosyan, ("It’s The Prices, Stupid: Why The United States Is So Different From Other Countries" ), ''Health Affairs'', Volume 22, Number 3, May/June 2003. Accessed February 27, 2008.〕 In spite of the amount spent on health care in the U.S., according to a 2008 Commonwealth Fund report, the United States ranks last in the quality of health care among developed countries.〔(【引用サイトリンク】url=http://www.bmj.com/content/337/bmj.a889.extract )〕 The World Health Organization (WHO), in 2000, ranked the US health care system 37th in overall performance and 72nd by overall level of health (among 191 member nations included in the study).〔(World Health Organization assess the world's health system ). Press Release WHO/44 21 June 2000.〕〔(Health system attainment and performance in all Member States, ranked by eight measures, estimates for 1997 )〕 International comparisons that could lead to conclusions about the quality of the health care received by Americans are subject to debate. The US pays twice as much yet lags other wealthy nations in such measures as infant mortality and life expectancy, which are among the most widely collected, hence easily compared, international statistics. Many people are underinsured, for example, in Colorado "of those with insurance for a full year, 36.3% were underinsured."〔(Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families—Findings from the Commonwealth Fund Biennial Health Insurance Surveys, 2001–2007 ). From the report: "In 2007, nearly two-thirds of U.S. adults, or an estimated 116 million people, struggled to pay medical bills, went without needed care because of cost, were uninsured for a time, or were underinsured (i.e., were insured but not adequately protected from high medical expenses)."〕 About 10.7 million insured Americans spend more than a quarter of their annual paychecks on health care because of the high deductible polices.〔(Report Finds Insurance Coverage Inadequate: Even Those Who Are Insured Struggle Making Medical Payments. ) From the statement, "Kathleen Stoll, health policy director at the Families USA consumer advocacy group, said 10.7 million insured Americans spend more than a quarter of their annual paychecks on health care."〕 The Patient Protection and Affordable Care Act (Public Law 111-148) was signed into law by President Barack Obama on March 23, 2010. Along with the Health Care and Education Reconciliation Act of 2010 (signed March 30), the Act is a product of the health care reform efforts of the Democratic 111th Congress and the Obama administration. The law includes health-related provisions to take effect over the next four years, including expanding Medicaid eligibility for people making up to 133% of the federal poverty level (FPL), subsidizing insurance premiums for people making up to 400% of the FPL ($88,000 for family of 4 in 2010) so their maximum "out-of-pocket" payment for annual premiums will be from 2% to 9.5% of income,〔(【引用サイトリンク】title=Policies to Improve Affordability and Accountability )〕〔(【引用サイトリンク】title=Health Care Reform Bill 101 )〕 providing incentives for businesses to provide health care benefits, prohibiting denial of coverage and denial of claims based on pre-existing conditions, establishing health insurance exchanges, prohibiting insurers from establishing annual coverage caps, and support for medical research. According to White House and Congressional Budget Office figures, the maximum share of income that enrollees would have to pay for the "silver" healthcare plan would vary depending on their income relative to the federal poverty level, as follows: for families with income 133–150% of FPL will be 3-4% of income, for families with income of 150–200% of FPL will be 4-6.3% of income, for families with income 200–250% of FPL will be 6.3-8.05% of income, for families with income 250-300% of FPL will be 8.05-9.5% of income, for families with income from 300 to 400% of FPL will be 9.5% of income.〔(【引用サイトリンク】title=Health Insurance Premiums (DHHS) )〕〔(【引用サイトリンク】title=Private Health Insurance Provisions in PPACA (P.L. 111-148) )〕〔(【引用サイトリンク】title=Health Insurance Premium Credits Under PPACA )〕 The costs of these provisions are offset by a variety of taxes, fees, and cost-saving measures, such as new Medicare taxes for those in high-income brackets, taxes on indoor tanning, cuts to the Medicare Advantage program in favor of traditional Medicare, and fees on medical devices and pharmaceutical companies;〔Peter Grier, (Health care reform bill 101: Who will pay for reform? ), ''Christian Science Monitor'' (March 21, 2010).〕 there is also a tax penalty for those who do not obtain health insurance, unless they are exempt due to low income or other reasons. The Congressional Budget Office estimates that the net effect of both laws will be a reduction in the federal deficit by $143 billion over the first decade.〔Congressional Budget Office, (Cost Estimates for H.R. 4872, Reconciliation Act of 2010 (Final Health Care Legislation) ) (March 20, 2010).〕 The universal health care proposal pending in the U.S. Congress is called the United States National Health Care Act (H.R. 676, formerly the "Medicare for All Act.") The Congressional Budget Office and related government agencies scored the cost of a universal health care system several times since 1991, and have uniformly predicted cost savings,〔Physicians for a National Health Program (January, 2008) ("Single Payer System Cost?" ) ''pnhp.org''〕 probably because of the 40% cost savings associated with universal preventative care〔Hogg, W., ''et al.'' (2005) ("Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis" ) ''BMC Health Services Research'' 5:20〕 and elimination of insurance company overhead costs. In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH) offered monetary incentives from 2011 to 2015 for adopting EHR technology to decrease the length of time for hospitals and other healthcare facilities to move from paper records to an electronic health record system. The technology, while not without its pitfalls, should allow easier documentation and storage, the ability to access the information from a bedside, and the ability to sync prescriptions with a bar code.〔(【引用サイトリンク】url=http://nursing.norwich.edu/the-future-of-nursing/ )〕 The Affordable Care Act was enacted with the goals of increasing the quality and affordability of health insurance, lowering the uninsured rate by expanding public and private insurance coverage, and reducing the costs of healthcare for individuals and the government. Health care providers receive payment more frequently as the number of insured people increases and the number of uninsured patients unable to pay out of pocket declines. Competition between insurers in the new health insurance marketplace has increased pressure on insurance companies to reduce premium rates, leading to reduced compensation rates to providers in some plans.〔Doctors Complain They Will Be Paid Less By Exchange Plans (November 19, 2013) ()〕 Many healthcare facilities are struggling to break even since the cost of providing health services has increased, due to wages, technology, and resources. Medicare reimbursement payments to health providers for orthopaedic procedures such as total knee arthroplasty, lumbar spine repair, open rotator cuff repair, and open ankle fracture repair, declined from 1992-2010 which means the providers must rely on self-pay patients and patients with commercial insurances to make up the difference. The changes in regulations regarding risk pool assessment and the inclusion of 10 essential health benefits to every insurance plan have also contributed to the rise in cost of insurance premiums. 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 reform」の詳細全文を読む スポンサード リンク
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