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美国持续应对精神疾病:经济学考量

America’s Continuing Struggle with Mental Illnesses: Economic Considerations
Journal of Economic Perspectives · 2023 · Richard G. Frank、Sherry Glied

中文摘要

精神疾病影响着约20%的美国人口。与其他健康状况一样,精神疾病给个人带来成本;同时,它还会产生由家庭成员乃至更广泛的社会承担的成本。精神疾病照护的演变路径与医疗卫生部门其他领域颇为不同。总体而言,医疗服务的治疗技术已经取得重大进步,但精神疾病治疗技术的进步程度却未达到同等水平。与其他疾病相比,精神疾病的照护成本增长较慢,而疾病的社会成本增长较快。本文提供证据,分析支撑这些模式的作用力量,并着重讨论精神疾病异质性所带来的挑战。我们考察了影响临床问题与治疗方法能否得到恰当匹配的制度和配给机制。最后,我们回顾了这些问题对政策和经济学研究的启示。

Abstract

Mental illnesses affect roughly 20 percent of the US population. Like other health conditions, mental illnesses impose costs on individuals; they also generate costs that extend to family members and the larger society. Care for mental illnesses has evolved quite differently from the rest of health care sector. While medical care in general has seen major advances in the technology of treatment this has not been the case to the same extent for the treatment of mental illnesses. Relative to other illnesses, the cost of care for mental illnesses has grown more slowly and the social cost of illness has grown more rapidly. In this essay we offer evidence about the forces underpinning these patterns and emphasize the challenges stemming from the heterogeneity of mental illnesses. We examine institutions and rationing mechanisms that affect the ability to make appropriate matches between clinical problems and treatments. We conclude with a review of implications for policy and economic research.
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