アメリカの地区保健センター(CHC)制度の盛衰と包括的プライマリケア《論文》
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概要
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The aim of this paper is to analyze the activities of Community Health Centers (CHCs) in the United States, to relate their history through various political administrations up to the present time, and to make clear their significance with regard to prevention, primary care, and social and support services in the comprehensive health care systems. Three quarters of the patient load at CHCs is made up of Medicaid recipients and the uninsured, and these centers are burdened with the problem that their patien referrals are frequently turned away by outside specialists. CHCs have offered comprehensive long-term care to 1.4 million elderly people, which has enabled these clients to continue living at home as long as possible. The overall significance of the CHCs has been to offer comprehensive community-based care to community residents; they have achieved both low medical costs and good quality medical care.For more than 40 years, CHCs have shown a strong ability to survive, resisting early pressure for abolition following their establishment as part of the Great Society policies in 1965. After surviving the hostile policies of both the Nixon and the Reagan administrations, they have continuously been able to support the American health care system. In fact, President G. W. Bush doubled the CHC grant budget during his term of office. President Obama, in order to secure medical treatment for the large number of uninsured Americans, is attempting to increase the patient usage of the CHCs from 20 million people to 40 million through his health care reform package. The United States are facing the urgent problem of achieving universal health insurance, and CHCs are standing in the forefront in providing a safety net for the uninsured. CHCs reduce the inequality of access to care, treat at-risk patients before their condition worsens, decrease the use of high cost medical institutions like emergency rooms or hospitals, and deliver medical treatment with high cost-effectiveness. Up to now, detailed research analyzing the history and activities of CHCs has not been carried out in Japan, to our loss. This paper is an attempt to remedy this deficiency.
論文 | ランダム
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