英语翻译The U.S.spends more on health care than any nation,and t

英语翻译
The U.S.spends more on health care than any nation,and the cost of health care has risen since the mid-1960s at a rate in excess of the rate of inflation or economic growth.Recent incremental health reform efforts have placed increasing emphasis on market forces.These forces have in turn created incentives to change the structure of the U.S.health system in order to achieve cost containment.In spite of increased spending on health care in the U.S.,we have not always improved health status (e.g.,infant mortality rate).Some of the answers to concerns about high cost and complaints about the quality of care are explained by the conditions under which administrative,and care decisions are made on a day-to-day basis.
According to Silva (1990),the nursing profession has been largely silent about ethical dilemmas in management practice.Such "silence" is perplexing given the frequency of ethical problems experienced by managers.Borawski (1995) conducted a survey of nurse managers and found that a high percentage (28%) had experienced conflict between the moral obligations of their practice and the moral obligations of the profession.Competent and effective nurse leaders and managers must be able to deal with a wide array of issues:social,political and ethical,in the performance of their duties (Brosnan and Roper,1997).This is critical not only to ensure the success of the organizations and systems in which they work but also to ensure that recipients of services obtain ethically appropriate quality care and treatment.In the past,those who provided health care were presumed to be governed by beliefs in a set of ethical and social responsibilities that took precedence over economic concerns.Whether or not all providers have been guided by such ideals,providers,managers and policy-makers alike must now take them into consideration along with the health needs of recipients and the financial ramifications of treatment.Today,some executives and managers are accountable to profit-oriented boards,depending upon the nature of the organization and its mission.State regulators must exercise regulatory oversight on local institutions associated with sophisticated multi-institutional arrangements.Some of these arrangements even span a variety of communities in different states.In the face of changing institutional missions and arrangements,third-party payers are likely to impose limits on expenditures based on criteria that neither reflect nor embody the traditional (altruistic) values previously associated with providing health care and professional service.

美国对卫生保健的时间还多比任何国家,医疗保健的成本上升速率mid-1960s以来超过通货膨胀率和经济增长.最近的增量卫生改革的努力将越来越重视对市场的力量.这些部队已经依次创造了激励结构的改变美国健康系统以达到控制成本.尽管在医疗方面的支出增加在美国,我们并不总是改善健康状况(例如,婴儿死亡率).几个答案担心成本高、护理质量的投诉说明了在多数情况下,行政管理及保健决定进行日常经营.

根据·席尔瓦(1990年),护理专业的服务,主要是保持缄默的道德困境管理实践.这样的“沉默”是一个复杂的问题给予伦理问题的频率所经历的经理.Borawski(1995)进行了一个调查,发现的护士经理相当高比率(28%)之间的冲突经历了从他们的做法和道德上的义务的道德责任的专业.有能力、高效的护士领导和管理人员必须有能力去处理各种各样的问题:社会、政治和道德,在履行其应尽的职责(·罗伯,1997).这是关键不仅要确保成功的组织和系统中,他们的工作,而是保证服务的接受者,获得道德关怀和治疗恰当的特性在过去,那些为卫生保健被推定应按照信仰一套社会和伦理责任,却饿着肚子经济利益.所有供应商是否已经遵循这样的理想,供应商,经理和决策者一样现在必须考虑随着健康需要收件人、金融的分枝治疗.今天,一些主管和经理负责根据板、以营利为目的的组织,它的性质任务.国家部门必须训练自己的监督管理机制在当地的机构以精良的多相关安排.这些安排的一些甚至跨越了一个不同的社区在不同的州.面对改变制度的任务和安排,倾向于使用第三方限制支出的基础上的准则,既不反映也体现着传统的(利他值)以前伴随提供医疗及完善的售后服务.