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首页> 外文期刊>Journal of health politics, policy and law >The form and context of federalism: meanings for health care financing.
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The form and context of federalism: meanings for health care financing.

机译：联邦制的形式和背景：卫生保健筹资的含义。

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This article examines the meaning of federalism for health care financing (HCF) and is based on two considerations. First, federal institutions are embedded in their national context and interact with them. The design and performance of HCF policy will be influenced by contexts, the workings of the federal institutions, and the interactions of these institutions with different elements of the context. This article unravels these influences. Second, there is no unique model of federalism, and so we have to specify the particular form to which we refer. The examination of the influence of federalism and its context on HCF policy is facilitated by using a transnational comparative approach, and this article examines four mature federations: the United States, Australia, Canada, and Germany. The relatively poor performance of the U.S. HCF system seems associated with the fact that it operates in a context markedly less benign than those of the other national HCF systems. Heterogeneity of context appears also to have contributed to important differences between the United States and the other countries in the design of HCF policies. An analysis of how federalism works in practice suggests that, while U.S. federalism may be overall less favorable to the development of well-functioning HCF policies, the inferior performance of these policies is to be principally attributed to context.
机译：本文探讨了联邦制对医疗保健筹资（HCF）的意义，并且基于两个考虑。首先，联邦机构融入其国情并与之互动。 HCF政策的设计和执行将受上下文，联邦机构的运作以及这些机构与上下文不同元素之间的相互作用的影响。本文揭示了这些影响。第二，联邦制没有独特的模式，因此我们必须指定所指的特定形式。通过使用跨国比较方法，可以方便地考察联邦制及其对HCF政策的影响，本文研究了四个成熟的联邦：美国，澳大利亚，加拿大和德国。美国HCF系统的相对较差的性能似乎与以下事实有关：该系统的运行环境明显比其他国家HCF系统的环境温和。背景的异质性似乎也导致了美国和其他国家在设计HCF政策方面的重要差异。对联邦制在实践中如何工作的分析表明，尽管美国联邦制总体上不利于运作良好的HCF政策的制定，但这些政策的较差表现主要归因于背景。

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