来源：科学网，高建国
7月11日，美国总统奥巴马（BarackHussein Obama）在医学专业杂志JAMA (The Journal of the AmericanMedical Association, If为37.684)发表特别通信(Special Communication)文章“United StatesHealth Care Reform - Progress to Date and Next Steps”，主要是阐述国家医改的好处，如，住院率自从实施医疗改革之后大幅下降。看到日理万机的世界超级大国在专业杂志上发表论文，有以下几点感想：
奥巴马选择专业性较强的、发源于1883年的JAMA发表，而不是Nature和Science (根据选题和数据估计也可以发)，说明任何时候专业一点总是好的，最起码给人以严谨求实的感觉。
遵守杂志要求与发表规范。不要以为总统发表文章就可以一路绿灯了。事实上，奥巴马的这篇文章经过长达两个月的审稿、编辑、修改和润色。（不知第一稿是什么样子？）
“While we of course recognized the author is the presidentof the United States, JAMA has enormously high standards and we certainlyexpected the president to meet those standards.”
Nonetheless, according to JAMA editor-in-chief Howard Bauchner,the article went through a two months of fact-checking and multiple edits andrevisions.
更多阅读：http://fortune.com/2016/07/11/obama-jama/
奥巴马是惟一作者，这点值得称道。
想说服大众，在专业的杂志上发表论文是一种很好的方式，特别是对教育层次较高的人有较大的说服力。
Publish or perish依然是学界（现在甚至是政界了）的金科玉律，总统都想通过发表专业杂志论文博得大家更理性和广泛的认可。我相信，奥巴马本人是非常想医改法案在他离职之后继续实施下去的，所以他通过这种特别的方式传递信息，估计更容易被大众理解和支持。
来源：科学网，周建
美国医疗改革取得的进展及其未来
重要性:美国在1965年就设计和颁布了医疗保险和医疗补助方面的一个重要法律制度：平价医疗法。对该法案的综合改革的宗旨是提高医疗保健的可及性、可承受性和医疗保健质量。
目的：分析到目前为止的、影响卫生改革决策的各种因素和该法案实施效果的总体证据，总结评价有关平价医疗法案在公共卫生政策层面的经验教训，推进医疗保健系统的质量改善。
证据：所有数据来自1963年到2016年初期间，涵盖了政府机构、研究机构的研究成果和其它可获得的公共数据资料。
发现：在应对美国医疗保健系统长期以来所面对的，在可及性、可承受性和医疗保健质量的巨大挑战方面，平价医疗法案取得了重大的进展。从该法案实施以来，美国人的未参保率从43%下降到2010年16%、2015年的9.1%，这主要得益于该法案的改革。研究结果表明，随之而来的改善包括：在可及性（例如，估计未到老年的成年人无法负担医疗费用的人数下降5.5个百分点）、经济保障（例如，估计医疗保险覆盖范围内的个人降低医疗债务600-1000美元）、健康水准（例如，估计未到老年的成年人报告健康水平持平或降低的人数下降3.4个百分点）几个方面。该法案也已经开展了在医疗保健支付系统的改革，估计原有联邦医疗模式中的30%参与了改革，他们选择了捆绑医疗或负责任医疗机构的替代模型进行医疗支付。这些改革已经在参保人逐步减少医药费用支出和提升医疗保健质量方面，显示出持续的效果。尽管获得了这样的进展，但是国家的医疗保健体系改革仍然需要继续。
结论：政策制定者应该依据平价医疗法案所取得的经验，继续推进医疗保险市场和运行系统的改革，增加联邦财政对医疗保险参保人的经费支持，引导身处个体市场竞争不足地域的公众合理规划医疗保险，采取行动降低处方药物的价格。虽然各有立场，依旧存在，但是平价医疗法案改革的成功示范，足以说明积极的变革在应对一些国家层面的复杂挑战是能够取得成效的。
United States Health Care Reform Progress to Date and NextSteps
BarackObama,JD
IMPORTANCE The Affordable Care Act is themost important healthcare legislation enacted in the United States since the creation ofMedicare andMedicaid in 1965. The law implemented comprehensive reforms designed toimprovethe accessibility, affordability, and quality of health care.
OBJECTIVES To review the factorsinfluencing the decision topursue health reform summarize evidence on the effects of thelaw to date,recommend actions that could improve the health care system, andidentifygeneral lessons for public policy from the Affordable Care Act.
EVIDENCE Analysis of publicly availabledata, data obtained fromgovernment agencies and published research findings. The periodexamined extendsfrom 1963 to early 2016
FINDINGS The Affordable Care Act has madesignificant progresstoward solving long-standing challenges facing the UShealth care system relatedto access, affordability, and quality of care. Since the AffordableCare Actbecame law, the uninsured rate has declined by 43%, from 16.0% in 2010 to9.1%in 2015, primarily because of the law's reforms.
Research has documented accompanying improvements in access tocare (for example, an estimated reduction in the share ofnonelderly adultsunable to afford care of 5.5 percentage points), financial security (forexample,an estimated reduction in debts sent to collection of 600− 600−1000 perperson gaining Medicaidcoverage), and health (for example, an estimated reductionin the share of nonelderly adultsreporting fair or poor health of 3.4percentage points). The law has also begun the processof transforming healthcare payment systems with an estimated 30% of traditionalMedicare payments nowflowing through alternative payment models like bundled payments oraccountablecare organizations. These and related reforms have contributed to asustainedperiod of slow growth in per-enrollee health care spending andimprovements in health carequality. Despite this progress, major opportunities toimprove the health care system remain.
CONCLUSIONS AND RELEVANCE Policy makersshould build on progressmade by the Affordable Care Act by continuing toimplement the Health InsuranceMarketplaces and delivery system reform, increasingfederal financial assistancefor Marketplace enrollees introducing a public plan option in areaslackingindividual market competition, and taking actions to reduce prescription drugcosts.Although partisanship and special interest opposition remain, experiencewith theAffordable Care Act demonstrates that positive change is achievable onsome of thenation's most complex challenges.
二0一六年七月十四日
Contact：j6789@163.com
原文：doi:10.1001/jama.2016.9797
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