RÉSUMÉ
The Affordable Care Act (ACA) was signed into law on March 23, 2010 and will fundamentally alter health care in the United States for years to come. The US is currently one of the only industrialized countries without universal health insurance. The new law expands existing public insurance for the poor. It also provides financial credits to low income individuals and some small businesses to purchase health insurance. By government estimates, the law will bring insurance to 30 million people. The law also provides for a significant new investment in prevention and wellness. It appropriates an unprecedented $15 billion in a prevention and public health fund, to be disbursed over 10 years, as well as creates a national prevention council to oversee the government's prevention efforts. This paper discusses 3 major prevention provisions in the legislation: 1) the waiving of cost-sharing for clinical preventive services, 2) new funding for community preventive services, and 3) new funding for workplace wellness programs. The paper examines the scientific evidence behind these provisions as well as provides examples of some model programs. Taken together, these provisions represent a significant advancement for prevention in the US health care system, including a shift towards healthier environments. However, in this turbulent economic and political environment, there is a real threat that much of the law, including the prevention provisions, will not receive adequate funding.
Sujet(s)
Humains , Réforme des soins de santé/législation et jurisprudence , Assurance maladie/législation et jurisprudence , Medicaid (USA)/législation et jurisprudence , Patient Protection and Affordable Care Act (USA) , Services de médecine préventive/législation et jurisprudence , États-UnisRÉSUMÉ
Periodic Health Examination and Prevention Guidelines for Koreans were first proposed since 1988. Based on that guideline, clinical preventive services has been applied to clinic population in a few University Hospitals since 1991. In 1995, LHMP development committee in Korean Academy of Family Physician Society first published evidence based clinical practice guidelines and updated the guidelines in 2003. Lifetime Health Maintenance Program (LHMP) commitee represents efforts to take a more updated evidence-based approach to the development of the third updated clinical practice guideline in 2009. We focused on approaches that can reliably assess the extent of updating required, a model of limited literature searches with modest expert involvement to reduce the cost and time.