潇湘渌水 @ 2010-07-12 10:25
哈佛的Berwick柏瑞克，前几天刚被Obama利用国会国庆recess期间认命为CMS（Centers for Medicare and Medicaid Services美国最大的健康服务purchaser，中国的前农合也叫CMS）的头，当然这个头还需要国会通过，不过即使不通过也可以做到明年年底，这还是一段很长的时间，毕竟Obama需要一个民主党的死忠监管每年8,000亿的花费，以及保证新的健康法案实施。
撇开Berwick偏好大政府、计划性的英式健康系统NHS，以至将引起共和党对其杯葛外，他本身的成就是有目共睹的。Berwick是健康服务质量方面的大牛级人物，有哈佛医学院的MD又有哈佛肯尼迪政治学院的MPP（居然没Phd，不过他年纪很大了），是IHI（健康服务改进研究所：一个致力于领导全球健康服务改进的非营利机构，Berwick的大本营）的头，当然他本人也是哈佛的儿科和卫生政策教授和医生。不过也难怪他“宁左勿右"，貌似跟经济没交集。他真的知道cost-effectives吗？他评估这么难办的健康服务质量真的符合人的偏好和理性吗？他以为的以病人为中心的服务就真的works吗？who knows？
----以下从NYT上摘录Berwick的“口才”----
In his book, “Escape Fire: Designs for the Future of Health Care,” Dr. Berwick sharply criticized “the dangerous, toxic and expensive assumption that more is better.” He insists that the nation can cut health costs without harming patients because vast sums are misspent.
“I have said before, and I’ll stand behind it, that the waste level in American medicine approaches 50 percent,” he said in an interview in the journal Health Affairs in 2005.
Dr. Berwick has championed efforts to “reduce the total supply of high-technology medical and surgical care” and to consolidate services in regional centers.
Long before the uproar over “death panels” last year, Dr. Berwick was urging health care providers to “reduce the use of unwanted and ineffective medical procedures at the end of life.”
“Using unwanted procedures in terminal illness is a form of assault,” he said in 1993 at the annual conference of his institute. “In economic terms, it is waste.”
On more than one occasion, Dr. Berwick has suggested a need for a cap on total health spending, with limits on annual increases.
In speeches and articles celebrating the 60th anniversary of Britain’s National Health Service in 2008, Dr. Berwick said he was “in love with the N.H.S.” and explained why it was “such a seductress.”
“The N.H.S. is not just a national treasure,” he wrote; “it is a global treasure.”
Among its virtues, he told a British audience, is that “you cap your health care budget.”
Instead of trying to protect the wealthy, Dr. Berwick wrote, the British recognized that “sick people tend to be poorer and that poor people tend to be sicker, and that any health care funding plan that is just must redistribute wealth.”
Dr. Berwick offered a suggestion to the British: “Please don’t put your faith in market forces.”
“In the United States,” he wrote, “competition is a major reason for our duplicative, supply-driven, fragmented care system.”
撇开Berwick偏好大政府、计划性的英式健康系统NHS，以至将引起共和党对其杯葛外，他本身的成就是有目共睹的。Berwick是健康服务质量方面的大牛级人物，有哈佛医学院的MD又有哈佛肯尼迪政治学院的MPP（居然没Phd，不过他年纪很大了），是IHI（健康服务改进研究所：一个致力于领导全球健康服务改进的非营利机构，Berwick的大本营）的头，当然他本人也是哈佛的儿科和卫生政策教授和医生。不过也难怪他“宁左勿右"，貌似跟经济没交集。他真的知道cost-effectives吗？他评估这么难办的健康服务质量真的符合人的偏好和理性吗？他以为的以病人为中心的服务就真的works吗？who knows？
----以下从NYT上摘录Berwick的“口才”----
In his book, “Escape Fire: Designs for the Future of Health Care,” Dr. Berwick sharply criticized “the dangerous, toxic and expensive assumption that more is better.” He insists that the nation can cut health costs without harming patients because vast sums are misspent.
“I have said before, and I’ll stand behind it, that the waste level in American medicine approaches 50 percent,” he said in an interview in the journal Health Affairs in 2005.
Dr. Berwick has championed efforts to “reduce the total supply of high-technology medical and surgical care” and to consolidate services in regional centers.
Long before the uproar over “death panels” last year, Dr. Berwick was urging health care providers to “reduce the use of unwanted and ineffective medical procedures at the end of life.”
“Using unwanted procedures in terminal illness is a form of assault,” he said in 1993 at the annual conference of his institute. “In economic terms, it is waste.”
On more than one occasion, Dr. Berwick has suggested a need for a cap on total health spending, with limits on annual increases.
In speeches and articles celebrating the 60th anniversary of Britain’s National Health Service in 2008, Dr. Berwick said he was “in love with the N.H.S.” and explained why it was “such a seductress.”
“The N.H.S. is not just a national treasure,” he wrote; “it is a global treasure.”
Among its virtues, he told a British audience, is that “you cap your health care budget.”
Instead of trying to protect the wealthy, Dr. Berwick wrote, the British recognized that “sick people tend to be poorer and that poor people tend to be sicker, and that any health care funding plan that is just must redistribute wealth.”
Dr. Berwick offered a suggestion to the British: “Please don’t put your faith in market forces.”
“In the United States,” he wrote, “competition is a major reason for our duplicative, supply-driven, fragmented care system.”
