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基于证据的医学的问题

西雅图—任何医疗体系都要平衡覆盖度、质量和成本——通常都会集中关注其中之一或之二而牺牲其他。比如,欧洲的医疗体系关注覆盖度、确保所有人都能获得医疗;与之相反,在美国,质量才是最重要的。

但是,不管你认为什么才是最重要的,显然美国在所有三个方面都有改进空间。幸运的是,美国已经采取措施改进所有三个领域。而美国的动作对其他国家也有影响。

美国患者保护和平价医疗法(Patient Protection and Affordable Care Act,现被广泛称为“奥巴马医保”的标志性立法)旨在扩大覆盖度,与此同时,凯撒医疗机构(Kaiser Permanente)等所谓的责任医疗组织试图通过协调医疗服务供应商和患者的利益控制成本。但是,通过应用基于证据的医学(evidence-based medicine,EBM)提高质量的做法有可能忽视我们所知道的的人类认知和专业知识,并且常常不利于医生的专业判断所起到的关键作用。

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