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在美国实现全民医疗保险覆盖:解决市场失灵,还是提供社会底线?

Achieving Universal Health Insurance Coverage in the United States: Addressing Market Failures or Providing a Social Floor?
Journal of Economic Perspectives · 2023 · Katherine Baicker、Amitabh Chandra、Mark Shepard

中文摘要

美国的医疗保健支出远高于大多数发达国家,但其未参保人口占比却更高。我们认为,以解决市场失灵为重点的渐进式保险扩张将使低效率问题延续下去,并且无助于推动为实现社会最优保险覆盖所必需的主动政策抉择。相反,政策制定者可以界定一个由公共财政为所有人提供资金的基本服务包,同时允许个人购买额外保险保障,从而既扩大保险覆盖,又维持创新激励,确保全民能够在一个可负担的体系中获得创新医疗服务。

Abstract

The United States spends substantially more on health care than most developed countries, yet leaves a greater share of the population uninsured. We argue that incremental insurance expansions focused on addressing market failures will propagate inefficiencies and will fail to facilitate the active policy decisions needed to achieve socially optimal coverage. By instead defining a basic bundle of services that is publicly financed for all, while allowing individuals to purchase additional coverage, policymakers could both expand coverage and maintain incentives for innovation, ensuring universal access to innovative care in an affordable system.
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