全民健保上路 醫護嚴重不足
編譯中心綜合華盛頓電
美國聯邦最高法院 28 日裁決，歐巴馬總統的健保法不違憲，美國醫學會(American Medical
Association，簡稱 AMA)很快發表聲明，表示支持。但 AMA 主席當選人何文 (Ardis Hoven) 29
日坦承，全美醫療專業人士擔心，健保體制驟增約 3000 萬人，醫護人員可能短缺不夠。
美國有線電視新聞網(CNN)指出，他們的關切是有道理的，泰國可以做為前車之鑑。泰國於
2002 年實施全民健保，全國健保體制因而增加 1400 萬投保人。結果是，醫院和診所病人大排
長龍，病人抱怨醫療品質不夠水準。
美國醫學院協會(Association of American Medical Colleges)指出，2010 年健保法簽字生效前，他
們已預期美國將發生醫生短缺。該協會現在估計，2015 年前，美國將缺少 6 萬 3000 名醫 生；
2025 年將缺少 13 萬 600 名醫生。
造成醫生短缺的因素很多，包括大量醫療專業人員即將達到退休年齡；即將達到退休年齡的病
人也大幅增加：今後數年，將近 1500 萬人有資格加入聯邦醫療保險(Medicare)。
此外，醫學院畢業生的住院醫生實習機會短缺，去年拿到醫學學位的畢業生，有 7000 人無法
到醫院住院實習。
許多住院醫生實習機會是由 Medicare 資助，醫院每年能申請的名額有上限。自 1997 年以來，
名額大約為 10 萬個，數額大致不變。
何文表示，最缺乏的將是家庭醫生(primary-care physician)。至於日益增加的預防性篩檢，最適
合由護士來做，但不幸的是，美國自 2000 年代初期就鬧護士荒。
AMA warns of upcoming shortage of doctors
Millions more Americans get health care, need physicians
Jun 30, 2012
(CNN) - When the Supreme Court upheld the Affordable Care Act in a 5-4 ruling Thursday, the
American Medical Association was quick to release a statement in support of the "historic" decision
that will give more people access to health coverage.
But (and there's always a "but") medical professionals across the country are wondering: When an
additional 32 million Americans get medical insurance, who exactly is going to treat them?
"We've expressed some concerns before about whether or not we're going to have enough physicians
out there," AMA President-Elect Ardis Hoven said.
1
They have good reason to worry. When Thailand enacted the "30-bhat scheme" in 2002, requiring all
patients to be covered by health insurance, 14 million people were added to the country's health care
system. The result was longer waits at the doctor's office and complaints of subpar service.
A physician shortage in the U.S. was expected even before the Affordable Care Act was signed into
law in 2010, according to the Association of American Medical Colleges. Now the group estimates
that there will be a shortage of 63,000 doctors by 2015 and 130,600 by 2025.
The shortage is a result of several factors. A large number of medical professionals are reaching
retirement age, as is a large group of patients: Nearly 15 million will become eligible for Medicare in
the coming years, the Association of American Medical Colleges reports.
On top of that, there is a lack of residency spots available for students graduating from medical school.
In 2011, more than 7,000 were left with degrees that said "M.D." but no place to continue their
education, according to the National Residency Matching Program.
Many residency spots are funded by Medicare, and there's a cap on the number a hospital can claim
each year. That number, about 100,000, has remained steady since 1997. While the Affordable Care
Act will redistribute some unused residency slots and increase funding for the National Health Service
Corps, more needs to be done, advocates say.
"There will be real physician shortages if we don't do more to lift the residency cap," said Dr. Atul
Grover, the Association of American Medical Colleges' chief advocacy officer, in a statement. "People
on both sides of the aisle have realized the need to train more doctors."
The biggest scarcity will be in primary-care physicians, Hoven said, thanks to better insurance
coverage for preventative care.
"I would like to note that these are not newly appeared patients," she said. "They've been in emergency
rooms, for things that are not necessarily an emergency. It's going to be a reshuffling of where they get
their care and when they get their care."
This, of course, is a good thing, Hoven said. Doctors will be able to detect diseases earlier and focus on
wellness, which in turn might lower health care costs. But that will require more internists, ob/gyns
and pediatricians -- at a time when many private practices are struggling to stay afloat financially.
Nurses would be a perfect fit to handle the increase in preventative medicine practices, said registered
nurse Karen Daley, president of the American Nurses Association. Nursing's holistic approach focuses
on wellness and community-based health needs.
Unfortunately, America has been talking about the nation's nursing shortage since the early 2000s, and
the numbers haven't improved.
"We're going to be facing serious shortages unlike anything we've ever seen in the next decade," Daley
said.
The American Nurses Association was a staunch supporter of the Affordable Care Act, and the group
wrote a brief in support of the legislation. Even if it's not a perfect law, Daley said, there are several
2
important protections that have been put in place, protections that will give access to millions who
otherwise might have avoided care.
But, there's always a "but."
"This is going to have to be a system that, in order to be effective, is going to have to be able to meet
demands for the work force. We need more resources to provide more access."
3