cindydaniel
Today, the foreign trade of the country or region's economic development is playing an increasingly important role. one country to achieve rapid economic development of economy must learn to use both international and domestic market. foreign trade, by removing the rewards of resources optimization disposition. the trade of the analysis is usually divided into of analysis and the structural analysis, the total amount is to analyze questions from the angle, and the structural analysis from the perspective of the importance of examining trade act.And structure of foreign trade is a national or regional economic development and industrial structure and commodities in international competition, in the international division of labour and international trade in a comprehensive response and commodity structure and regional structure is an important part of the structure of foreign trade. china's accession to wto in 2001, foreign trade has increased rapidly to become the united states, the two countries of the world's third largest trader, but with the rapid development of our foreign trade.The structural problems more and more manifest, for example, the commodity structure is irrational and exports remained low added value of products. moreover, our foreign trade in merchandise trade is far greater than service trade, so the study of our foreign trade structure is a study of our product import and export commodity structure, optimize. the article from our foreign trade structure of goods and regional structure has to start.Analysed our import and export trade, and finally made to realize the import and export of strategic goals. the article falls into five chapters, the first three chapters to focus on the development of our foreign trade and the structure of foreign trade in goods and regional structure, the fourth chapter, the introduction of our foreign trade, most of the current structure of foreign trade import and export trade and development in order to achieve the strategic objective measures and export of the regrouping.當今社會，對外貿(mào)易在國家或者地區(qū)的經(jīng)濟發(fā)展中扮演著越來越重要的角色。一國要獲得經(jīng)濟快速的經(jīng)濟發(fā)展，必須學會利用國際國內(nèi)兩個市場。通過對外貿(mào)易，進行物產(chǎn)的互通有無，從而實現(xiàn)資源的優(yōu)化配置。對貿(mào)易行為的分析通常分為總量分析和結(jié)構(gòu)分析，總量分析是從量的角度分析問題，而結(jié)構(gòu)分析更注重從質(zhì)的角度考察貿(mào)易行為。而對外貿(mào)易結(jié)構(gòu)是一國或地區(qū)經(jīng)濟技術(shù)發(fā)展水平、產(chǎn)業(yè)結(jié)構(gòu)狀況、商品國際競爭能力、在國際分工和國際貿(mào)易中的地位等的綜合反映，而商品結(jié)構(gòu)和區(qū)域結(jié)構(gòu)是對外貿(mào)易結(jié)構(gòu)的重要組成部分。中國從2001年加入WTO以來，對外貿(mào)易快速增長，以成為即美、日兩國以后的世界第三大貿(mào)易國，但是隨著我國對外貿(mào)易的快速發(fā)展，在結(jié)構(gòu)上的問題越來越多的顯現(xiàn)出來，例如商品結(jié)構(gòu)的不合理，出口產(chǎn)品仍然是低附加值產(chǎn)品。而且，我國的對外貿(mào)易中商品貿(mào)易額遠遠大于服務(wù)貿(mào)易額，因此研究我國的對外貿(mào)易結(jié)構(gòu)主要是研究我國的商品進出口貿(mào)易，達到商品結(jié)構(gòu)的優(yōu)化。本文將從我國對外貿(mào)易結(jié)構(gòu)中的商品結(jié)構(gòu)和區(qū)域結(jié)構(gòu)入手，來分析我國的進出口貿(mào)易，最后提出為了實現(xiàn)進出口貿(mào)易戰(zhàn)略目標的措施。全文分為五章，前三章主要講我國對外貿(mào)易的發(fā)展現(xiàn)狀和對外貿(mào)易結(jié)構(gòu)中的商品結(jié)構(gòu)和區(qū)域結(jié)構(gòu)的分析,第四章講,我國在引入外資時對我國進出口貿(mào)易的影響,最針對當前的對外貿(mào)易結(jié)構(gòu),提出進出口貿(mào)易發(fā)展中為了實現(xiàn)戰(zhàn)略目標的措施和出口商品的優(yōu)化措施。
好吃的小藍
Macroeconomics is a sub-field of economics that examines the behavior of the economy as a whole, once all of the individual economic decisions of companies and industries have been summed. Economy-wide phenomena considered by macroeconomics include Gross Domestic Product (GDP) and how it is affected by changes in unemployment, national income, rate of growth, and price levels. In contrast, microeconomics is the study of the economic behaviour and decision-making of individual consumers, firms, and industries. Macroeconomics can be used to analyze how to influence government policy goals such as economic growth, price stability, full employment and the attainment of a sustainable balance of payments. Macroeconomics is sometimes used to refer to a general approach to economic reasoning, which includes long term strategies and rational expectations in aggregate behavior. Until the 1930s most economic analysis did not separate out individual economics behavior from aggregate behavior. With the Great Depression of the 1930s, suffered throughout the developed world at the time, and the development of the concept of national income and product statistics, the field of macroeconomics began to expand. Particularly influential were the ideas of John Maynard Keynes, who formulated theories to try to explain the Great Depression. Before that time, comprehensive national accounts, as we know them today, did not exist . One of the challenges of economics has been a struggle to reconcile macroeconomic and microeconomic models. Starting in the 1950s, macroeconomists developed micro-based models of macroeconomic behavior (such as the consumption function). Dutch economist Jan Tinbergen developed the first comprehensive national macroeconomic model, which he first built for the Netherlands and later applied to the United States and the United Kingdom after World War II. The first global macroeconomic model, Wharton Econometric Forecasting Associates LINK project, was initiated by Lawrence Klein and was mentioned in his citation for the Nobel Memorial Prize in Economics in 1980. Theorists such as Robert Lucas Jr suggested (in the 1970s) that at least some traditional Keynesian (after British economist John Maynard Keynes) macroeconomic models were questionable as they were not derived from assumptions about individual behavior, although it was not clear whether the failures were in microeconomic assumptions or in macroeconomic models. However, New Keynesian macroeconomics has generally presented microeconomic models to shore up their macroeconomic theorizing, and some Keynesians have contested the idea that microeconomic foundations are essential, if the model is analytically useful. An analogy might be that the fact that quantum phisics is not fully consistent with relativity theory doesn′t mean that realtivity is false. Many important microeconomic assumptions have never been proved, and some have proved wrong. The various schools of thought are not always in direct competition with one another - even though they sometimes reach differing conclusions. Macroeconomics is an ever evolving area of research. The goal of economic research is not to be "right," but rather to be accurate. It is likely that none of the current schools of economic thought perfectly capture the workings of the economy. They do, however, each contribute a small piece of the overall puzzle. As one learns more about each school of thought, it is possible to combine aspects of each in order to reach an informed synthesis. The traditional distinction is between two different approaches to economics: Keynesian economics, focusing on demand; and supply-side (or neo-classical) economics, focusing on supply. Neither view is typically endorsed to the complete exclusion of the other, but most schools do tend clearly to emphasize one or the other as a theoretical foundation. ? Keynesian economics focuses on aggregate demand to explain levels of unemployment and the business cycle. That is, business cycle fluctuations should be reduced through fiscal policy (the government spends more or less depending on the situation) and monetary policy. Early Keynesian macroeconomics was "activist," calling for regular use of policy to stabilize the capitalist economy, while some Keynesians called for the use of incomes policies. ? Supply-side economics delineates quite clearly the roles of monetary policy and fiscal policy. The focus for monetary policy should be purely on the price of money as determined by the supply of money and the demand for money. It advocates a monetary policy that directly targets the value of money and does not target interest rates at all. Typically the value of money is measured by reference to gold or some other reference. The focus of fiscal policy is to raise revenue for worthy government investments with a clear recognition of the impact that taxation has on domestic trade. It places heavy emphasis on Say's law, which states that recessions do not occur because of failure in demand or lack of money. ? Monetarism, led by Milton Friedman, which holds that inflation is always and everywhere a monetary phenomenon. It rejects fiscal policy because it leads to "crowding out" of the private sector. Further, it does not wish to combat inflation or deflation by means of active demand management as in Keynesian economics, but by means of monetary policy rules, such as keeping the rate of growth of the money supply constant over time. ? New Keynesian economics, which developed partly in response to new classical economics, strives to provide microeconomic foundations to Keynesian economics by showing how imperfect markets can justify demand management. ? Austrian economics is a laissez-faire school of macroeconomics. It focuses on the business cycle that arises from government or central-bank interference that leads to deviations from the natural rate of interest. ? Post-Keynesian economics represents a dissent from mainstream Keynesian economics, emphasizing the role of uncertainty and the historical process in macroeconomics. ? New classical economics. The original theoretical impetus was the charge that Keynesian economics lacks microeconomic foundations -- i.e. its assertions are not founded in basic economic theory. This school emerged during the 1970s. This school asserts that it does not make sense to claim that the economy at any time might be "out-of-equilibrium". Fluctuations in aggregate variables follow from the individuals in the society continuously re-optimizing as new information on the state of the world is revealed. Later yielded an explicit school which argued that macro-economics does not have micro-economic foundations, but is instead the tool of studying economic systems at equilibrium. 宏觀經(jīng)濟學是一種分場經(jīng)濟學的行為,研究是在整個經(jīng)濟中,一旦所有的個人的經(jīng)濟決策,為公司和產(chǎn)業(yè)被。宏觀經(jīng)濟學認為經(jīng)濟現(xiàn)象包括國內(nèi)生產(chǎn)總值(GDP)以及它是如何變化影響失業(yè)的國民收入的)經(jīng)濟成長率、價格水平。相反,微觀經(jīng)濟學研究的就是經(jīng)濟行為和決策的個體消費者,公司和行業(yè)。宏觀經(jīng)濟學可以用來分析如何影響政府的政策的目標,比如經(jīng)濟增長,價格穩(wěn)定,充分就業(yè)和獲取可持續(xù)國際收支差額。宏觀經(jīng)濟學有時用來指一個經(jīng)濟理論的主要途徑,包括長期戰(zhàn)略的期望和理性綜合行為。直到30年代為止,大部分的經(jīng)濟分析沒有獨立的個人經(jīng)濟綜合行為舉止。與1930年代的經(jīng)濟大蕭條,遭受了在所有發(fā)達國家,發(fā)展國民收入的概念和產(chǎn)品的統(tǒng)計數(shù)據(jù),但是研究領(lǐng)域的宏觀經(jīng)濟學開始擴展。具有特殊影響力的想法是,約翰?梅納德凱恩斯理論,努力向他們解釋制定了經(jīng)濟大蕭條。在那時候,綜合國民經(jīng)濟核算,如同我們知道他們今天,是不存在的。經(jīng)濟學的一個挑戰(zhàn)是一場斗爭調(diào)和宏觀經(jīng)濟政策和微觀經(jīng)濟政策,模型。開始于20世紀50年代,macroeconomists發(fā)達micro-based模型的宏觀經(jīng)濟行為(如消費函數(shù))。1月Tinbergen荷蘭經(jīng)濟學家第一個全面發(fā)展國家宏觀經(jīng)濟模型,該模型他第一次建成為荷蘭和后應(yīng)用于美國和英國二戰(zhàn)之后。第一個全球宏觀經(jīng)濟模型,沃頓計量預(yù)測伙伴聯(lián)系工程項目,發(fā)生在勞倫斯發(fā)起克萊恩和被提及他的嘉獎經(jīng)濟學諾貝爾經(jīng)濟學獎1980年。理論家如羅伯特·盧卡斯認為(是在上世紀70年代),認為至少有一些傳統(tǒng)的凱恩斯(英國經(jīng)濟學家約翰梅納德凱恩斯)宏觀經(jīng)濟模型都是可疑的,因為他們不是來源于假設(shè)的個人行為,雖然現(xiàn)在還不清楚這些失敗在微觀經(jīng)濟的假定,或是對宏觀經(jīng)濟模型。然而,最新凱恩斯主義的宏觀微觀模型提出了大致以支持他們的宏觀經(jīng)濟理論有爭議,一些凱恩斯主義者的想法,微觀經(jīng)濟基礎(chǔ)是必要的,如果模型是分析有用的。打個比方可能是,這樣的事實,即量子phisics并不完全符合相對論′,并不代表沒有realtivity是假的。許多重要的微觀經(jīng)濟假設(shè)從來沒有被證明,而有些人的證明是錯誤的。各種各樣的思想學派并不總是在彼此的直接競爭,盡管他們有時會達到不同的結(jié)論。宏觀經(jīng)濟學是一種前所未有的領(lǐng)域的研究。研究經(jīng)濟學的目標不是"正確",而是是精確的。很有可能是學校目前尚無一個經(jīng)濟思想完全捕捉運作方式的經(jīng)濟。不過,他們的貢獻每一小塊整體難題。當你學會更多關(guān)于每個思想學派,它能把方面的每一個為了達到一個通知的合成。傳統(tǒng)的區(qū)別是留給經(jīng)濟學兩種不同的方法,重點凱恩斯經(jīng)濟學和供方需求;(或古典)經(jīng)濟學、關(guān)注供應(yīng)。也都是典型的觀點完全排除其他,但大多數(shù)學校都往往清晰地強調(diào)一個或另一個是的理論基礎(chǔ)。?凱恩斯經(jīng)濟學交融在總需求,以解釋失業(yè)率和商業(yè)周期。商業(yè)周期波動,應(yīng)減少通過財政政策(政府花費或多或少根據(jù)實際情況)和貨幣政策。早期凱恩斯主義的宏觀經(jīng)濟學是“活動家,定期使用《召喚的政策穩(wěn)定資本主義經(jīng)濟,雖然有些凱恩斯主義要求使用收入政策。?供給的經(jīng)濟學的作用很明顯地在當前貨幣政策與財政政策。關(guān)注于貨幣政策應(yīng)該是完全對價格的錢所確定的貨幣供應(yīng)的需求的特點,為了金錢。它提倡貨幣政策,直接目標錢的價值,不目標利率。典型的錢的價值在于用參考金或其他參考。財政政策的重點是提高政府農(nóng)業(yè)投資價值的收入為一個明確的認識稅收的影響在國內(nèi)貿(mào)易。它設(shè)置了過度強調(diào)了說的法律,它表明不會發(fā)生經(jīng)濟衰退需求下降、因為沒有缺錢。?貨幣主義的帶領(lǐng)下,由弗里德曼,認為始終通貨膨脹是一種貨幣現(xiàn)象。財政政策拒絕,因為會導致“擠退”的私人生活。此外,它不希望對抗通貨膨脹或通貨緊縮采用主動需求管理在凱恩斯經(jīng)濟學,通過貨幣政策規(guī)則,即堅持的增長速度恒定的錢。凱恩斯?新經(jīng)濟發(fā)達的部分原因是為了適應(yīng)新古典經(jīng)濟學、致力于提供凱恩斯現(xiàn)代經(jīng)濟學的微觀經(jīng)濟基礎(chǔ)顯示出了市場的不完善就能名正言順的需求管理等。?奧地利經(jīng)濟學是個自由放任主義的學校的宏觀經(jīng)濟。它側(cè)重于商業(yè)周期,而政府或中央銀行的干擾導致偏離自然失業(yè)率的興趣。?Post-Keynesian經(jīng)濟學所代表了凱恩斯經(jīng)濟學主流的作用,強調(diào)歷史過程中不確定性和宏觀經(jīng)濟。?新古典經(jīng)濟學。原理論動力的費用是凱恩斯經(jīng)濟學缺乏有效的微觀經(jīng)濟基礎(chǔ)——亦即其斷言不成立于基本經(jīng)濟理論。這所學校出現(xiàn)在20世紀70年代。這所學校斷言它是沒有道理的主張經(jīng)濟會隨時out-of-equilibrium”。波動的總變量遵從的在這個社會的個人不斷re-optimizing新信息的狀態(tài)的世界就會顯現(xiàn)出來。后來取得了一個顯式學校一樣,認為宏觀經(jīng)濟學沒有微觀經(jīng)濟基礎(chǔ),反而學習經(jīng)濟系統(tǒng)的工具在平衡。
lucaminiya
Health careA new prescription for the poor為貧窮者新開的處方America is developing a two-tier health system, one for those with private insurance, the other for the less well-off美國正在發(fā)展一個雙重的健康系統(tǒng)，一重是為那些有個人保險的人群，而另一重則是為那些不那么富裕的人群Oct 8th 2011 | NEW YORK | from the print edition“IT’S time for Dancing with the Stars!”, a woman announces enthusiastically. At this New York health centre, wedged between housing projects to the east and Chinatown to the west, “dancing with the stars” means dancing with a physical therapist. An old man stands up with a nurse and begins a determined samba.“是時候和明星一起跳舞了！”一位女士滿懷熱情地宣告。在這個坐落于房屋工程的西面，唐人街東面的紐約健康中心，“和明星起舞”的意思是和一位物理治療師跳舞。一位老者和一個護士站起來，開始跳事先確定好的桑巴舞。Comprehensive Care Management (CCM), which runs this centre, tries to keep old people active. To do so, explains Joseph Healy, the chief operating officer, is in the company’s best interest. The government pays CCM a capped rate for the care of its members. If someone gets sick, his health costs rise and the company’s margin shrinks. Mr Healy argues that the system is the best way to provide good care at a low cost. Increasingly others seem to agree.經(jīng)營這個中心的綜合護理管理部門（CCM）努力保持老人們的活力。約瑟夫-海莉，首席運營官解釋說，這樣做符合公司的最佳利益。政府給這個部門一個封頂?shù)慕蛸N來讓他們照顧這些人。如果有人生病了，他的健康成本就會上升，公司的利潤就會萎縮。海莉先生確定說這個系統(tǒng)能夠在一個低成本上提供最佳的護理。其他人也逐漸同意這個觀點。Medicaid, America’s health programme for the poor, is in the process of being transformed. Over the next three years, New York will move its entire Medicaid population into “managed care”, paying companies a set rate to tend to the poor, rather than paying a fee for each service. New York is not alone. States from California to Mississippi are expanding managed care. It is the culmination of a steady shift in the way most poor Americans receive their health-care treatment.公共醫(yī)療補助，即美國的窮人健康計劃，正在被改造的過程中。在接下來的 三年內(nèi)，紐約將把整個接受窮人健康計劃的人群納入“管理關(guān)懷”之中，付給公司們一個事先定好的費用來照顧那些窮人，而不是按照項目來付費。紐約不是唯一這樣做的州。加州，密西西比州正在拓展管理關(guān)懷計劃。這代表一種正在進行中的穩(wěn)步轉(zhuǎn)變，即大部分貧窮美國人接受健康關(guān)懷方式的轉(zhuǎn)變。Medicaid is America’s single biggest health programme. This year roughly one in five Americans will be covered by Medicaid for a month or more. It gobbles more federal and local money than any state programme, other than education. Costs will rise even more when Barack Obama’s health-care reform expands the programme by easing eligibility rules in 2014. Congress’s “supercommittee” is already considering cuts. However, there are more immediate pressures behind the present drive for change.公共醫(yī)療補助是美國最大的單一健康計劃。今年，五個美國人中的一個就會被納入該計劃一個月或更長時間。除了教育之外，它比其他任何州的財政計劃耗去更多聯(lián)邦和地方的經(jīng)費。當2014年奧巴馬的健康保險改革放寬適用人群而使整個計劃更加龐大的時候，成本將會進一步上升。眾議院的“超級委員會”已經(jīng)在考慮削減經(jīng)費。然而，選擇這種變化，將會有更多即刻的壓力存在。Enrolment in Medicaid jumped during the downturn, from 42.7m in December 2007 to 50.3m in June 2010. Mr Obama’s stimulus bill helped to pay for some of this, but that money has dried up. Faced with gaping deficits, some desperate governors slashed payments to hospitals and doctors, or refused to pay for trips to the dentist or oculist. But much the most important result has been structural: the expansion of managed care.公共醫(yī)療補助計劃的參與人數(shù)在經(jīng)濟滑坡期間從2007年12月的 4270萬人跳到了2010年6月的5030萬人。奧巴馬先生的經(jīng)濟刺激經(jīng)費能夠幫助付掉其中的一部分，但是錢已經(jīng)被用光。面對資金短缺，一些絕望的州長砍掉了給醫(yī)院和醫(yī)生的補助，或是拒絕支付牙醫(yī)和眼科醫(yī)生的旅行費用。但是，更多地，最重要的結(jié)果是結(jié)構(gòu)上的：管理關(guān)懷的拓展。States have dabbled in managed care for decades. The trend accelerated in the 1990s, with the share of Medicaid patients under this form of care reaching 72% by 2009. Now, however, there is a strong push for the remainder. States that did not have managed care, such as Louisiana, are introducing it. Other states are extending it to people previously deemed off limits: California and New York, for example, are moving the elderly and disabled into that system of care. Texas is targeting more than 400,000 Medicaid beneficiaries in the Rio Grande Valley. Local politicians had resisted the move, nervous that care might deteriorate. But the yawning deficit meant that they were overruled.各個州涉足管理關(guān)懷已經(jīng)有幾十年的歷史了。這個趨勢在90年代得到加速發(fā)展，在2009年前使用這種護理方式的公共醫(yī)療補助病人占到了72%?，F(xiàn)在，對于剩下的人，這也是很強的推動力。像路易斯安那州這樣沒有管理關(guān)懷的州正在引進管理關(guān)懷。其他州也把這個拓展到原先被認為不適用的人群：舉例說像加州和紐約州，正在把老人和殘障人士納入這個系統(tǒng)中，德州的目標是在格蘭德河谷超過400000公共醫(yī)療補助收益人群。地方政治家反對這個舉動，他們擔心這個護理系統(tǒng)將會變質(zhì)。但是巨大的赤字意味著他們的觀點注定要被批駁。The result is a country with two distinct tiers of health care. Most Americans with private insurance are still horrified by thoughts of health-management organisations and prefer to pay fees for each medical service. For the poor, managed care is becoming the norm.結(jié)果就是一個國家有兩套截然不同的健康保險系統(tǒng)。大多數(shù)有個人保險的美國人仍舊害怕那些健康管理組織的想法而寧愿為單獨的醫(yī)療服務(wù)付費。對于窮人來說，管理關(guān)懷已經(jīng)成為一種常規(guī)。Advocates of managed care have high expectations. First, they hope that it will make costs more predictable. Second, they believe that the change will improve patients’ health. In managed care, a patient has a network of doctors and specialists. If the programme works properly, doctors can monitor all aspects of care, in contrast to the fragmented fee-for-service system. The contracts that states have with firms can set standards for quality. Texas, for instance, will cut 5% from a company’s payment if it does not meet what is required.管理關(guān)懷的鼓吹者有著很高的期待。首先，他們希望這能讓成本變得可以預(yù)測，其次，他們相信，這個改變可以改善病人的健康。在管理關(guān)懷中，一個病人有一個由醫(yī)生和專家組成的網(wǎng)絡(luò)。如果這個計劃運行良好，醫(yī)生可以監(jiān)測關(guān)懷的各個方面，相對于分離的的按服務(wù)付錢的系統(tǒng)來說。州政府和公司的合同可以為質(zhì)量定下標準。德州，舉例說，將會在付款中扣除5%如果公司沒有達到要求的標準。The next step is to integrate care for those eligible for both Medicaid and Medicare, the federal programme for the old. These “duals” account for almost 40% of Medicaid’s costs and just 15% of its population. “If managed care can really deliver better care than fee-for-service”, says Diane Rowland, chair of the commission that advises Congress on Medicaid, “this is the population that could prove it.”下一步是整合那些同時符合公共醫(yī)療補助和長者醫(yī)療補助計劃（聯(lián)邦老人醫(yī)療補助）的人群。這些“雙符合”人群占據(jù)了將近40%的公共醫(yī)療補助成本和僅僅15%的人口數(shù)量。“如果管理關(guān)懷能真正比按項目付費帶來更好的服務(wù)”，戴安-羅蘭德，委員會（指導國會在公共醫(yī)療補助政策上進行決策）主任說：“這是一群能證明管理關(guān)懷可行的人?！盉ut some, such as Norma Vescovo, are sceptical. As the head of the non-profit Independent Living Centre of Southern California (ILCSC), Ms Vescovo serves Medicaid patients with severe health problems. Over the years she has often sued California on policies that she thinks will hurt her vulnerable clients. On October 3rd her case moved to the Supreme Court.但是一些人，例如像諾瑪-凡斯科夫就對此表示懷疑。作為非盈利的南加州獨立生活中心主任，凡斯科夫女士服務(wù)于那些有嚴重健康問題的接受公共醫(yī)療補助的病人。在這些年間，她經(jīng)?？馗婕又菡谝恍┱呱蠒λ囊恍┐嗳醯目蛻?。在10月3日，她的案子被移到了上訴法院。The outcome of Douglas v Independent Living Centre will have profound implications for the future of Medicaid. Ms Vescovo’s suit concerns cuts to hospitals and doctors. But the case will also guide the course of managed care. If ILCSC and its co-plaintiffs win, private groups will continue to be able to challenge states on policies they think violate federal Medicaid law. Ms Vescovo, who argues that California’s payment cuts would eviscerate her clients’ access to services, worries that under managed care the disabled might not be able to see the specialists they need.道格拉斯 v 獨立生活中心的結(jié)果將會對公共醫(yī)療補助有深遠的意義。凡斯科夫女士的訴訟影響到醫(yī)院和醫(yī)生的津貼削減。但是這個案子將會引領(lǐng)管理關(guān)懷的進程。如果中心和其他原告勝訴，私人團體將會繼續(xù)在那些他們認為違反聯(lián)邦法律的政策上挑戰(zhàn)州政府。凡斯科夫女士認為說加州的支付削減計劃會讓她的客戶失去得到服務(wù)的機會，她還擔心，在管理關(guān)懷之下，那些殘障人士可能不能見到那些他們需要的專家。The question is how to supervise the experiments with managed care that are being carried out in various states. To date, Medicaid beneficiaries have been able to challenge the states in court. However, if the Supreme Court rules against ILCSC, that avenue will be closed. The Centres for Medicare and Medicaid Services (CMS) technically can intervene if states do not provide proper access to care. In reality, CMS has few tools to do so.問題是怎么監(jiān)管在不同州試運行的管理關(guān)懷。到目前為止，公共醫(yī)療補助受益者已經(jīng)能夠在法庭中挑戰(zhàn)政府。然而，如果上訴法庭結(jié)果不利于中心，那么這條路將會被關(guān)閉。如果州政府沒有提供合適的關(guān)懷的話，公共醫(yī)療補助和長者醫(yī)療關(guān)懷中心理論上是能對此進行干涉，但事實上，他們沒有太多辦法?！癐’m a big fan of managed care”, says Sara Rosenbaum, a professor at George Washington University, “but this transformation may happen with almost no federal oversight.” Medicaid beneficiaries are vulnerable, in worse health than Americans as a whole. Companies may struggle to cut costs and provide good care as well. If states do not draft their contracts properly, or fail to be vigilant in monitoring patients’ health, their experiment in managed care could be a disaster. On the other hand, if states are careful they could provide an answer to the question that has vexed America for years: how to provide good, cheap health care.“我是管理關(guān)懷的擁護者”，薩拉-羅森博姆，一位喬治華盛頓大學教授說，“但是這種轉(zhuǎn)變可能在沒有聯(lián)邦監(jiān)管的情況下發(fā)生?！惫册t(yī)療補助的受益者和你脆弱，健康程度整體上比一般美國人要差。公司可能在削減成本的同時掙扎著同樣提供良好的服務(wù)。如果州政府們不好好起草他們的合同，或沒有警覺地監(jiān)控病人的健康的話，他們在管理關(guān)懷上的實驗可能會是一場災(zāi)難。另一方面，如果州政府們認真的話，他們能為那個困擾美國人多年的問題提供答案，即怎么提供優(yōu)質(zhì)的便宜的健康關(guān)懷。
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