清朝皇帝简介

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清朝皇帝简介
Special Communication
游行13, 2018
美国和其他高收入国家的医疗保健支出
作者单位 文章信息
  • 1哈佛T.H.陈公共卫生学院卫生政策与管理系,马萨诸塞州波士顿
  • 2哈佛全球健康研究所,马萨诸塞州剑桥
  • 3伦敦政治经济学院卫生政策系,英国伦敦清朝皇帝简介
贾玛 2018; 319(10):1024-1039。 doi:10.1001 / jama.2018.1150
Audio Author Interview (18:22)
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Key Points

清朝皇帝简介 ? 为什么美国的医疗保健支出比其他高收入国家大得多?

发现? 2016年,美国在医疗保健上的支出几乎是10个高收入国家的两倍,而在许多人口健康方面的表现却不佳。与对高额支出的某些解释相反,美国的社会支出和医疗保健利用与其他高收入国家并无实质性差异。包括药品和器械在内的劳动力和商品价格以及行政成本似乎是支出差异的主要驱动因素。

含义? 仅针对利用的努力不可能减少美国医疗保健支出的增长。可能需要更加协调一致的努力来降低价格和管理成本。

抽象

重要性? 美国的医疗保健支出是一个主要问题,比其他高收入国家要高,但是几乎没有证据表明改革美国医疗保健提供的努力对控制医疗保健支出和成本产生了有意义的影响。

目的? 比较美国与10个收入最高的国家(英国,加拿大,德国,澳大利亚,日本,瑞典,法国,荷兰,瑞士和丹麦)以了解美国可以从这些国家那里学到什么。

证据? 分析主要来自主要国际组织(包括经济合作与发展组织(OECD))2013-2016年的数据,比较美国和十大高管之间的结构特征,医疗保健和社会支出类型以及绩效方面的根本差异-收入国家。如果无法提供给定国家的数据,或者可以从经合组织以外的来源获得更准确的国家级估计,则使用特定国家的数据源。

发现? 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.

结论与相关性? 美国在医疗保健上的花费大约是其他高收入国家的两倍,但美国的利用率在很大程度上与其他国家相似。包括药品在内的劳动力和商品价格以及行政成本似乎是美国与其他高收入国家之间总体成本差异的主要驱动因素。随着患者,医生,政策制定者和立法者积极辩论美国卫生系统的未来,需要这些数据来为政策决策提供依据。

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