MAKAPOB wrote:AKBApuyc wrote:MAKAPOB wrote:Митяй wrote:
Жру что дают, Макаров. Поскольку на выбор есть всего два, максимум четыре варианта. Для больных и здоровых.
Судя по тону вашего ответа, от "жрать, что дают" вы не в восторге...
Что сказал намедни Обама о своей мед реформе? Пересказываю по памяти:
"Как изначально social security было предназначено только для вдов и сирот, но создало основу для нынешней системы, так и наша мед реформа создала основу для последующих изменений". Угадайте-ка, когда (если) последующие изменения будут воплощены в жизнь, будет у вас выбор из "всего два, максимум четыре варианта" или нет?
Мне так думается, что нет...
какого выбора нас собираются лишить ?
Полагаете, single payer система даст вам выбор из single payer и?..
А сейчас вы вдумчиво читаете список из нескольких тысяч процедур, их покрытие различными страховками, и выбираете для себя наиболее подходящую ?
Это у вас сегодня такой выбор ?
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And the way the government controls the flow of money is that we have multiple payers and multiple providers, but there's a single-payment system -- not a single payer but a single-payment system -- so that all payers must abide by the payment system, and all providers must be paid by the system.
So this is like a valve, so that if the government wants to contain costs, it can cut, ... and that decreases the flow of money, or at least it contains the increase in the flow of money. This is done by a two-step method. The first step is that the prime minister himself decides how much the macro increase will be.
How much the total medical expense budget is going to go up?
Right. ... Having made that the first step, the second step is how to allocate that [increase] among the various procedures and drugs. And in this we have a completely different approach to that of the United States, where you, in Medicare, ... it's an across-the-board conversion factor, so that if there's a 2 percent decrease, it would be applied 2 percent for every single procedure in the surgical and in the medical procedures.
But in Japan this is done on a procedure-by-procedure basis and by a drug-by-drug basis, and the way that is done is that a survey is made of the financial situation of the providers.
So you're saying the government has the power to determine these prices, what they're going to pay. Don't the providers, hospitals, have power in pricing?
They can certainly negotiate, but after making the first-step decision I was saying -- prices are going to be decreased by 3 percent -- then everything must be fitted within that. So certain prices may go up, certain prices may go down, but in general, the final results should be that the overall budget should be as set by the first step, a 3 percent reduction.
Every two years, when they set the cost for things, they publish them in this big telephone-book-like manual. And everything's in there?
Right.
So there's one price for sutures and another price for stitches?
Yeah. If it's more than 10 square inches, it will be this amount; if it's less than 10 square inches, it will be this amount. So it's very finely defined. ...
А пристыдишь их - и сальцо найдется, и горилочка...
Сомневаюсь, что вы будете тем самым "добрым дядей", которого этот вопрос развеселит... Вот я и не понимаю - откуда это страстное желание "добровольно и с песней" кормить разбухший госаппарат своими кровными...