中文摘要：

美国是世界上实行市场主导型医疗保障体制国家的典型代表，其医疗保障体制具有市场化、分散性、复杂性和混合性等特点，但同时面临着医疗费用急剧上涨、效率相对低下和公平性不足等问题。为解决这些问题，美国医疗保障体制处于不断改革之中。本文首先分析了美国医疗保障体制面临的问题，然后重点介绍20世纪90年代克林顿政府的医疗改革方案和21世纪初小布什政府的医疗改革思路，最后对这些改革方案进行评析。

英文摘要：

American health care system is a typical market-based system. Its health care system is characterized by marketization, diversity, complexity and mixedness. Meanwhile, it is faced with such problems as dramatic increase in health expenditure, relative inefficiency and lack of equality. To solve these problems, its health care system is under constant reform. This paper firstly analyzes the problems in American health care system, then mainly introduces Clinton Administration＇s Health Care Reform Proposal in 1990s and Bush Administration＇s Reform Plans in early 21.st century,and finally makes comments on these reforms.