[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（英文）

1、International Journal of Health Care Quality AssuranceHealthcare reforms and cost reduction strategies in Europe: The cases of Germany, UK, Switzerland, Italy and France Daniel SimonetArticle information:To cite this doc

2、ument: Daniel Simonet, (2010),“Healthcare reforms and cost reduction strategies in Europe“, International Journal of Health Care Quality Assurance, Vol. 23 Iss 5 pp. 470 - 488 Permanent link to this document: http://dx.d

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10、on correct at time of download.Downloaded by DONGHUA UNIVERSITY At 19:22 17 January 2015 (PT)system. Nevertheless, it offered a generous protection to workers; for example, the first industrial laws held firms responsibl

11、e for work injuries. Its influence was great in Italy, France and Sweden. Beveridge (Churchill’s Health Minister) model is a more recent and liberal doctrine. It was developed in a working paper compiled in Great Britain

12、 and diffused in 1942 under the title Social Insurance and Allied Services that came into effect in 1948. It imposed universal coverage (which differs from the Bismarck model because it was not restricted to salaried wor

13、kers). Beveridge was funded through taxation and also responded to many other non-health concerns (e.g. unemployment benefits and retirement pension) while remaining faithful to its liberal inspiration. It offered limite

14、d compensation and benefits in order to incite individuals to return quickly to the job market. Its influence extended to Scandinavian countries where benefits were more generous. While both models inspired European Unio

15、n (EU) healthcare systems, their impact and timing differed greatly across the UK and Germany. The British system opted for a radical and rapid transformation in 1948; the German model followed an incremental approach wi

16、th progressive healthcare coverage for its citizens. In the UK, population coverage was only 10 per cent when the Beveridge model was adopted and reached about 70 per cent as early as 1950 with the NHS’s creation, offeri

17、ng 100 per cent coverage. In contrast, universal coverage was achieved much later in Germany, through incremental extension to other social groups (Ba ¨rnighausen and Sauerborn, 2002) such as the self-employed (1972

18、), students (1975) and artists (1981). Pensioners were only included in the health/sickness insurance scheme in 1941, some disabled people in 1953 and 1957, and all disabled people in 1975.Germany: a Bismarck regime with

19、 more competition The German state is not responsible for managing health expenditure. These are handled by regional and professional (i.e. local) sickness funds; e.g. Allgemeine Ortkrankenkassen (AOK); for private compa

20、nies: Betriebskrankenkassen (BKK), which included large companies such as Krupp and Bayer; for corporations, craftsmen and tradesmen: Innungkrankenkassen (IKK), which is derived from Guild-based sickness funds; and farme

21、rs: Landwirtschaftliche Krankenkassen (LKK). The AOK fund takes care of blue-collar workers and employees, even though the latter can turn to a sickness fund for employees (Ersatzkassen) if they wish. Civil servants are

22、covered by another insurance regime. These organisations, to which low and medium-income citizens must subscribe, operate nationally and are partially autonomous; that is, they fix premiums, manage their own resources an

23、d negotiate fees directly with medical professions. Their activity is regulated because patient contribution rates are decided by a committee that meets twice yearly. Premiums and health services are monitored by law, wh

24、ich guarantees stability to the current health system and offers a safety net to the most vulnerable, e.g. pensioners. Sickness fund managers concentrated on their activities: they were fewer than 500 in 1998 with an ave

25、rage 100,000 members per sickness fund. That number fell to 420 in 2000, and on 1 January 2007, there were 242 statutory sickness funds. Insurance company attempts to control German hospital efficiency were unsuccessful

26、(Lungen and Lapsley, 2003). The German healthcare system was based on the Hospital Financing Act (1972): the federal government controls hospital planning and construction; paying for it while theHealthcare reforms471Dow