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[JAMA最新论文]:1996年至2013年间美国医疗卫生费用增加的相关因素
2017年11月23日 时讯速递, 进展交流 暂无评论

Original Investigation

November 7, 2017

Factors Associated With Increases in US Health Care Spending, 1996-2013

Joseph L. Dieleman, Ellen Squires, Anthony L. Bui, et al.

JAMA. 2017;318(17):1668-1678

doi:10.1001/jama.2017.15927

Abstract

Importance 背景

Health care spending in the United States increased substantially from 1995 to 2015 and comprised 17.8% of the economy in 2015. Understanding the relationship between known factors and spending increases over time could inform policy efforts to contain future spending growth.

从1995年到2015年间美国医疗卫生费用大幅度增加,至2015年时已占经济总量的17.8%。深入了解各种已知影响因素与医疗费用增加之间的关系,可以使政策制定者更好了控制今后医疗费用的增加。

Objective 面对

To quantify changes in spending associated with 5 fundamental factors related to health care spending in the United States: population size, population age structure, disease prevalence or incidence, service utilization, and service price and intensity.

定量分析与美国医疗卫生费用相关的5个基本因素(人口,年龄结构,疾病患病率或发病率,医疗服务使用情况以及医疗服务价格和强度)相关的费用改变。

Design and Setting 设计与场景

Data on the 5 factors from 1996 through 2013 were extracted for 155 health conditions, 36 age and sex groups, and 6 types of care from the Global Burden of Disease 2015 study and the Institute for Health Metrics and Evaluation’s US Disease Expenditure 2013 project. Decomposition analysis was performed to estimate the association between changes in these factors and changes in health care spending and to estimate the variability across health conditions and types of care.

根据全球疾病负担2015年研究数据以及健康评估研究所有关美国疾病花费2013年数据,得到1996年至2013年间155种疾病,36个年龄及性别分组,以及6种治疗措施的相关数据。通过分解分析估计上述因素改变与医疗卫生费用增加之间的相关性,并评估各种不同疾病及治疗措施的变异度。

Exposures 暴露

Change in population size, population aging, disease prevalence or incidence, service utilization, or service price and intensity.

人口,年龄构成,疾病罹患率或发病率,医疗服务使用情况以及医疗服务价格和强度。

Main Outcomes and Measures 主要预后指标

Change in health care spending from 1996 through 2013.

从1996年至2013年医疗卫生费用的变化

Results 结果

After adjustments for price inflation, annual health care spending on inpatient, ambulatory, retail pharmaceutical, nursing facility, emergency department, and dental care increased by $933.5 billion between 1996 and 2013, from $1.2 trillion to $2.1 trillion. Increases in US population size were associated with a 23.1% (uncertainty interval [UI], 23.1%-23.1%), or $269.5 (UI, $269.0-$270.0) billion, spending increase; aging of the population was associated with an 11.6% (UI, 11.4%-11.8%), or $135.7 (UI, $133.3-$137.7) billion, spending increase. Changes in disease prevalence or incidence were associated with spending reductions of 2.4% (UI, 0.9%-3.8%), or $28.2 (UI, $10.5-$44.4) billion, whereas changes in service utilization were not associated with a statistically significant change in spending. Changes in service price and intensity were associated with a 50.0% (UI, 45.0%-55.0%), or $583.5 (UI, $525.2-$641.4) billion, spending increase. The influence of these 5 factors varied by health condition and type of care. For example, the increase in annual diabetes spending between 1996 and 2013 was $64.4 (UI, $57.9-$70.6) billion; $44.4 (UI, $38.7-$49.6) billion of this increase was pharmaceutical spending.

针对物价上涨因素进行校正后,每年住院患者、门诊患者、药品零售、护理结构、急诊科以及牙科的医疗费用,从1996年的12000亿美元增加至2013年的21000亿美元,增加9335亿美元。美国人口的增加伴随23.1%的医疗费用增加(不确定性区间 [UI], 23.1%-23.1%),或 2695 亿美元 (UI, 2690-2700) ;人口老龄化伴随11.6% (UI, 11.4%-11.8%) 的医疗费用增加,或1357 (UI, 1333-1377) 亿美元。疾病发病率或患病率伴随医疗费用下降2.4% (UI, 0.9%-3.8%),或 282 (UI, 105-444) 亿美元,而医疗服务使用情况并不伴随医疗费用显著改变。医疗服务价格及强度伴随医疗费用增加 50.0% (UI, 45.0%-55.0%),或 5835 (UI, 5252-6414) 亿美元。这5种因素的影响收到疾病种类及治疗措施的影响。例如,1996年至2013年间,每年糖尿病治疗费用增加644 (UI, 579-706) 亿美元;其中药品花费的增加占444 (UI, 387-496) 亿美元。

Conclusions and Relevance 结论与意义

Increases in US health care spending from 1996 through 2013 were largely related to increases in health care service price and intensity but were also positively associated with population growth and aging and negatively associated with disease prevalence or incidence. Understanding these factors and their variability across health conditions and types of care may inform policy efforts to contain health care spending.

1996年至2013年间,美国医疗卫生费用增加在很大程度上与医疗服务价格和强度增加有关,但也与人口增加及老龄化呈正相关,与疾病发病率或患病率呈负相关。了解上述因素以及在不同疾病和治疗措施的变化,可能有助于政策制定者显著医疗费用。

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