[JAMA最新论文]:美国及其他高收入国家的医疗卫生费用 | 中国病理生理学会危重病医学专业委员会
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[JAMA最新论文]:美国及其他高收入国家的医疗卫生费用
2018年03月23日 时讯速递, 进展交流 暂无评论

Special Communication

March 13, 2018

Health Care Spending in the United States and Other High-Income Countries

Irene Papanicolas, Liana R. Woskie, Ashish K. Jha

JAMA. 2018;319(10):1024-1039. doi:10.1001/jama.2018.1150

Abstract

Importance 背景

Health care spending in the United States is a major concern and is higher than in other high-income countries, but there is little evidence that efforts to reform US health care delivery have had a meaningful influence on controlling health care spending and costs.

美国的医疗卫生费用超过其他高收入国家,但仅有很少证据表明,美国医疗卫生改革对控制医疗卫生费用能够产生影响。

Objective 目的

To compare potential drivers of spending, such as structural capacity and utilization, in the United States with those of 10 of the highest-income countries (United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland, and Denmark) to gain insight into what the United States can learn from these nations.

比较美国及其他10个高收入国家(英国,加拿大,德国,澳大利亚,日本,瑞典,法国,荷兰,瑞士和丹麦)医疗卫生费用的主要影响因素,如结构能力与利用率,以便了解美国究竟能够从这些国家学习到什么。

Evidence 证据

Analysis of data primarily from 2013-2016 from key international organizations including the Organisation for Economic Co-operation and Development (OECD), comparing underlying differences in structural features, types of health care and social spending, and performance between the United States and 10 high-income countries. When data were not available for a given country or more accurate country-level estimates were available from sources other than the OECD, country-specific data sources were used.

对2013-2016年间来自主要国际组织包括经济合作与发展组织(OECD)的数据进行分析,比较美国与10个高收入国家结构特征、医疗卫生和社会费用种类,以及执行情况等方面的差异。如果缺乏某个国家的数据,或OECD以外的其他来源能够提供更准确的数据,则使用该国家的数据。

Findings 结果

In 2016, the US spent 17.8% of its gross domestic product on health care, and spending in the other countries ranged from 9.6% (Australia) to 12.4% (Switzerland). The proportion of the population with health insurance was 90% in the US, lower than the other countries (range, 99%-100%), and the US had the highest proportion of private health insurance (55.3%). For some determinants of health such as smoking, the US ranked second lowest of the countries (11.4% of the US population ≥15 years smokes daily; mean of all 11 countries, 16.6%), but the US had the highest percentage of adults who were overweight or obese at 70.1% (range for other countries, 23.8%-63.4%; mean of all 11 countries, 55.6%). Life expectancy in the US was the lowest of the 11 countries at 78.8 years (range for other countries, 80.7-83.9 years; mean of all 11 countries, 81.7 years), and infant mortality was the highest (5.8 deaths per 1000 live births in the US; 3.6 per 1000 for all 11 countries). The US did not differ substantially from the other countries in physician workforce (2.6 physicians per 1000; 43% primary care physicians), or nursing workforce (11.1 nurses per 1000). The US had comparable numbers of hospital beds (2.8 per 1000) but higher utilization of magnetic resonance imaging (118 per 1000) and computed tomography (245 per 1000) vs other countries. The US had similar rates of utilization (US discharges per 100 000 were 192 for acute myocardial infarction, 365 for pneumonia, 230 for chronic obstructive pulmonary disease; procedures per 100 000 were 204 for hip replacement, 226 for knee replacement, and 79 for coronary artery bypass graft surgery). Administrative costs of care (activities relating to planning, regulating, and managing health systems and services) accounted for 8% in the US vs a range of 1% to 3% in the other countries. For pharmaceutical costs, spending per capita was $1443 in the US vs a range of $466 to $939 in other countries. Salaries of physicians and nurses were higher in the US; for example, generalist physicians salaries were $218 173 in the US compared with a range of $86 607 to $154 126 in the other countries.

2016年,美国的医疗卫生费用占GDP的17.8%,其他国家为 9.6%(澳大利亚)至 12.4%(瑞士)不等。美国90%的人口具有医疗保险,低于其他国家(范围,99%-100%),且美国私人医疗保险比例最高 (55.3%)。对于某些健康决定因素而言,如吸烟,美国的比例较低,在上述国家中排名第二(美国≥15岁以上人口中 11.4% 每日吸烟;11个国家平均值,16.6%),但是,美国成年人超重或肥胖的比例最高,为 70.1%(其他国家 23.8%-63.4%;11个国家均值,55.6%)。在11个国家中,美国的预期寿命最低,为 78.8 岁(其他国家,80.7-83.9 岁;11个国家均值,81.7 岁),婴儿死亡率最高(美国每1000例活产中5.8例死亡;11个国家均值,每1000例活产3.6例死亡)。与其他国家相比,美国的医生人力(每1000人2.6名医生;43% 为家庭医生)或护理人力(每1000人11.1名护士)并无显著差别。与其他国家相比较,美国医院床位数相似(每1000人2.8张),但核磁共振成像(每1000人118次)及CT(每1000人245次)使用率较高。美国医疗资源使用率与其他国家相似(每100000出院病人中,急性心梗192例,肺炎 365 例,慢性阻塞性肺病230例;每100000次操作中,髋关节置换204例,膝关节置换 226 例,冠脉搭桥79例)。在美国,医疗管理费用(与医疗卫生系统及服务的计划、调整及管理相关的活动)占8%,其他国家则为 1% - 3% 。在药品费用方面,美国每人花费 $1443,其他国家花费$466 - $939。美国的医生和护士工资较高;例如,美国全科医生工资为 $218 173,其他国家则为 $86 607-  $154 12。

Conclusions and Relevance 结论和意义

The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries. As patients, physicians, policy makers, and legislators actively debate the future of the US health system, data such as these are needed to inform policy decisions.

美国的医疗卫生费用相当于其他高收入国家的2倍,但美国医疗资源利用率总体上与其他国家相似。人力和商品(包括药品)成本以及管理费用似乎是造成美国及其他高收入国家总体费用差异的主要因素。在患者、医生、政策制定者以及立法者就美国医疗卫生系统的未来进行辩论时,需要根据上述数据进行政策决策。

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