Question

麻烦英译中翻译，要人工的。

Several factors may explain the absence of clear effects of these “pay for performance” reforms on health and costs. First, improvements in particular aspects of care may not translate into overall health improvements, or they may be offset by reduced quality of care or higher costs in dimensions that are not measured well. Second, many of these reforms were implemented only by particular payers (like Medicare or a private insurance plan), and so the overall changes in incentives for providers who receive income from a variety of sources may have been relatively modest. Third, because the pay-for-performance reforms generally affected only some providers of care, effects on overall utilization and costs may have been mitigated. For example, medical home payments support better coordination by primary care providers, but do not directly support better care by specialists or create accountability for lowering overall costs.

Answer 1

有几个因素可以解释“绩效工资”，这些改革对健康和成本没有明显的影响。首先，在特别的护理方面的改进可能不会转化为整体健康状况的改善，或者他们可能会降低护理质量或尺寸不测量以及较高的成本所抵消。其次，这些改革中，许多人只能由特定的纳税人（如医疗保险或私人医疗保险计划）实施，所以在鼓励供应商收到来自各种来源的收入的整体变化，可能已相对温和。第三，由于支付按业绩普遍受影响的只是一些保健提供者的改革，整体利用率和成本的影响可能已经缓解。例如，医家金支持初级保健提供者进行更好的协调，但不直接支持由专家更好的照顾，或为降低总体成本创造问责。

Answer 2

以下几方面原因能解释清楚为什么“依据表现支付账目”在医疗卫生及费用的改革上成效甚微。
一、针对一些特殊需求所提出的改革并没有切实转变为在医疗卫生方面提升的助力，或者是这些改革需求在监管不到位的地方，没有充分得以实行，因此成效不大；
二、这些医疗改革措施的补充部分仅仅是像医疗救助和医疗保险等方面受益多，而最广大的普通受众却因为接受资源的限制很难享受到这种改革措施所带来的实惠。
三、因为“依据表现支付账目”仅仅对医疗救助和医疗成果有所帮助，而在整体的利用和整体的花费方面的作用却没有多大的助益。另外，“依据表现支付账目”也因为不支持专业医疗和降低整体的医疗费用，而作用低微。个人意见，仅供参考！