今天我們就讀完了醫療制度為主題的這篇文章。
前面我們先看到了新加坡在實施的制度，後面主要是美國醫療制度的問題，以及和新加坡醫療制度的對比和如何改革美國醫療制度。
本文出自《財富》雜誌，文章主要以肖恩·馬薩基·弗林在書籍《The Cure That Works 》中提出的內容，總結了美國醫療制度現存的問題。
我們一起來看這剩下的最好一部分。
後續發現有意思的醫療相關的文章會在分享給大家，感謝閱讀。
加大拿、英國、法國和其他國家的單一支付制度怎麼樣呢？
弗林直白地展示了他們是如何控制開支的：通過限額配給。患者需要等很久才等到專科醫師而根據年齡和狀況進行治療，也或許根本得不到治療。自由市場衛生保健方法在美國行得通嗎？當然。
已經在使用的兩個例子是選擇性整容手術以及鐳射視力矯正手術，這兩項都不包括在醫保里。儘管如此，對這兩項手術的需求都大幅上升。結果呢？在過去20年里，手術效果得到提升，受通脹影響，鐳射視力矯正手術價格下降僅50%，整容手術下降25%。
印第安納州提供了另一個例子。
回到2007年，其為州員工提供了一種高免賠額的健康儲蓄帳戶（HSA）選擇。免賠額是2750美元，印第安納州每年都把這筆錢存入員工的HSA，成為員工的個人財產。超出免賠額的部分，員工需要支付20%，可高達8000美元；超出部分全由保險公司支付。
因此，一年的自付費用總額上限為1000美元多一點。
參與該計劃的員工減少了35%的支出，因為他們突然有了讓醫療費用有價值的動力，比如選擇仿製藥而非更加昂貴的品牌藥以及去急性治療診所看病，而不是急著去昂貴的醫院急診室。弗林無可辯駁的底線：我們應該大力推行HSAs這種高免賠額健康保險政策，由僱主支付免賠額，且醫療提供方要公布一切開支的價格。
進行這種深刻變革的條件或許已經成熟。僱主們已經在爭取高免賠額的政策，但許多人並沒有把它們納入到強有力的HSAs中。此外，不必要的限制使HSAs的實施並不順利，比如禁止使用HSAs購買非處方藥。
首先，華盛頓應該要求保險公司在提供傳統保險的基礎上再提供這樣的保險，並且應該取消那些HSA的限制。
此外，印第安納州也為其醫療補助計劃成功開創了一種新加坡式的方法。
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.
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.
