医疗卫生支出：历史趋势与新方向

中文摘要

过去五十年来，美国医疗卫生体系的广泛变革深刻影响了医疗卫生支出的增长。本文综述了推动医疗支出增长的主要因素，以及这些因素如何影响了卫生经济学研究的发展轨迹。我们发现，相关研究识别出——并且深受其影响——四个支出增长时期：第一阶段，医疗保障覆盖范围扩大；第二阶段，尝试运用经济激励；第三阶段，对管理式医疗的抵制；第四阶段，支出增速下降的黄金时代。最后，我们讨论了这类研究呈现的一些主题，这些主题使我们有理由乐观地认为，展望未来，我们可以在不损害人口健康的前提下，遏制超过GDP增速的过度支出增长。

Abstract

Over the past five decades, broad changes in the US health care system have dramatically influenced growth in health care expenditures. This review identifies the salient factors driving the growth of medical expenditures and how they influenced the trajectory of health economics research. We find that the research identified—and was strongly influenced by—four eras of expenditure growth: period 1, coverage expansion; period 2, experimentation with financial incentives; period 3, the managed care backlash; and period 4, a golden era of declining expenditure growth. We conclude by discussing some themes from this research suggesting optimism that, going forward, we can curb excess expenditure growth above GDP growth without harming population health.