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Question

政府建立了三类主要医疗保险项目：医疗保险(Medicare)，医疗补贴(Medicaid)和通过联邦所得税税制对私人保险的隐含补贴。政府医疗补贴(Medicaid)项目，在很大程度上带有财政转移支付的功能。医疗补贴项目与医疗保险项目的区别是，前者是为贫困者而设，医疗补贴大约包括了低收入者住院治疗费用的80%，不足部份通过医院对私人投保者提高收费来解决。后者是为老年人而设，二者之间没有直接联系。由于私人保险公司自身不可能胜任规模如此庞大、涉及面如此广的医疗保险，政府介入老年人医疗保险市场。医疗保险中隐含的政府补贴按照联邦税法，个人的工资收入需要同时交纳社会保险工薪税和个人所得税。由雇主交纳的医疗保险费不必交税。自我雇用的私人业主，医疗保险费用的25%是免税的。

在美国的老年人全部医疗保健支出中，医疗保险(Medicare)，包括住院医疗保险(HI)和补充性医疗保险(SMI)，二者合计约占44%。医疗补贴(Medicaid)约占12%，个人自负和私人保险公司支付合占约44%。

（三）低收入医疗保险

目前政府低收入医疗保险分为儿童(Child Health Plus)及家庭(Family health Plus)两种。就儿童来说，以0～19岁但不超过19岁，这一方面政府把关较松，如果父母临时失业等，政府无论如何都会替小孩投保的，但如果父母的收入突然增多，超过标准则需收一点点的月费；家庭保费，则是指19～65岁的成人，只要收入不超过政府规定单身或夫妻俩人的的收入低于低限标准，都可以获得低收入的医疗保险。

(四)医疗保险福利金

医疗保险福利金分A部分和B部分。A 部份是强制性的住院医疗保险(HI)，用于支付住院费用，护理机构费用以及部分在家中接受医疗的化费。B 部份为自愿性的"补充性医疗保险"(SMI)，用于支付院外医生诊费，门诊费用和某些家中医疗费用。

二、美国医疗保险制度的特点

医疗保险是美国的社会保险福利之一。美国的企业和个人必须参加住院保险，交纳住院保险税。符合规定的投保者因病住院可报销大部分医疗费用。年满65岁的投保老人、残疾人及未享受社会保险的65岁以上的老人通过每月支付保险费可参加并享受补充医疗保险。

美国医疗保健制度存在的主要问题是对医疗市场实行非组织化的管理体制，即实行的是“非管理保健”（non-managed care），在全国缺乏统一有效的管理措施，因此突出地反映在以下三个方面：①第三方付款制度易造成过度的医疗需求，投保人每月向保险公司支付一定保险金额后（包括雇主支付部分），患病时可自由选择医师或医院就诊，然后向保险公司报帐，大部分由保险公司支付，这种制度是按服务项目偿付（fee for service）的制度，属于后付款制（post payment system）的偿付类型的优点是方便病人，可满足病人需求自由选择，缺点是医疗保险费难以控制；②缺乏控制医疗费用的动力机制，医生和医院为了增加收入就会出现两种突出情况，一是诱导病人扩大医疗需求，造成大处方、滥检查；另一是把无利可图的或疑难病人推向非营利性医疗，前者增加保险公司的支出，后者加大政府的开支。③享受卫生保健的不公平性，穷人和富人的差距很大。

Answer 1

The Government had established three categories of major medical insurance coverage: health insurance (Medicare), medical subsidies (Medicaid) and the tax system through the federal income tax on private insurance, the implied subsidies. Government medical subsidies (Medicaid), to a large extent with the financial transfer payment functions. Medical subsidies and medical insurance project is the difference between a project, which is designed for the poor, about health care subsidies to low-income, including the cost of hospital treatment of 80 percent, less than most private insurance through the hospital to raise fees to resolve. The latter is designed for the elderly, there is no direct link between the two. As private insurance companies can not own such a large scale of competence, such a wide scope of medical insurance, government intervention in the elderly health insurance market. Medical insurance implied in the federal tax laws in accordance with government subsidies, individual wages need to pay social insurance payroll taxes and personal income tax. By the employer to pay medical insurance premiums do not have to pay tax. Self-employed by private owners, and medical insurance costs of 25 percent is tax-free.

All the elderly people in the U.S. health care spending, medical insurance (Medicare), including hospital medical insurance (HI) and supplementary medical insurance (SMI), the two together accounting for about 44 percent. Medical subsidies (Medicaid) accounted for about 12 percent, and private individuals own the insurance companies paid a total of about 44 percent.

(C) low-income medical insurance

Government health insurance is divided into low-income children (Child Health Plus) and family (Family health Plus) two. On children, with 0 to 19-year-old but not more than 19 years old, this area to ensure the less, if the parents temporary unemployment, the Government will in any case on behalf of children insured, but if the parents of a sudden increase in revenue, more than the standard To be a little bit on fees; family premium, it refers to 19 to 65-year-old adults, as long as the income does not exceed the provisions of the俩人single or couples with incomes below the lower limit standards, can get the low-income medical insurance .

(D) medical insurance benefits

Health insurance benefits at the Part A and Part B. A part of the mandatory in-patient medical insurance (HI), to cover hospitalization costs, the cost of care institutions at home and part of the medical costs. B for the voluntary part of the "supplementary medical insurance" (SMI), used to cover hospital doctor consultation fees, outpatient fees and some home health care costs.

Second, the United States the characteristics of the medical insurance system

U.S. medical insurance is one of the social insurance benefits. U.S. businesses and individuals to participate in hospitalization insurance, payment of hospital insurance tax. Meet the required hospitalization due to illness can be insured claims the majority of medical expenses. The age of 65-year-old insurance elderly, the disabled and did not enjoy social insurance for the elderly aged over 65 monthly premium can be paid to participate in and enjoy supplementary medical insurance.

U.S. health care system is the main problem is that the market for medical organizations of the non-implementation of the management system, that is, practicing the "non-managed care" (non-managed care), the country lacks a unified and effective management measures, so prominently reflected in The following three aspects: ① third-party payment system easy to cause excessive medical needs, the insured monthly payments to insurance companies after a certain amount of insurance (including the employer to pay part), the sick, are free to choose a physician or hospital, then to Insurance companies accounted for most of the insurance company to pay, such a system is based on payment services (fee for service) system, are after the payment system (post payment system) type of payment of the benefits is to facilitate patients to meet patients Demand freedom of choice, the shortcomings of health insurance is difficult to control; ② lack of control medical costs of power mechanism, doctors and hospitals in order to increase revenue there will be two prominent cases, first-induced expansion of medical needs of patients, resulting in the prescription, over inspections; Another is to unprofitable or difficult patients to non-profit health care, the former insurance companies to increase spending, which increased government expenditure. ③ to health is not fair, poor and the gap between the very rich.

Answer 2

楼上的，我服了！
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