美国卫生费用上涨和控制及对我国的启示

Cost escalating and control measures of U.S.health spending and its implications to China

长期以来,美国卫生费用总量与人均水平居世界首位并保持了较高的增长速度,对于该国政治、经济、社会与人民生活等产生了严重影响。美国卫生费用居高不下的主要原因包括对重点人群和疾病的费用控制措施不力、卫生体制过于复杂导致管理成本过高、人力成本和服务价格过高等。在过去40多年里,虽然美国根据限制、整合和竞争等原则采取了诸多费用控制措施,但收效不大。借鉴美国的相关经验教训并结合我国实际情况,本文的主要建议包括:(1)重视完善的卫生体制在费用控制中的重要作用;(2)在医药卫生体制改革中不宜过分提倡市场化;(3)政府在卫生费用控制中应发挥关键性作用并充分发挥医疗保险机构和医疗服务提供者的作用;(4)在支付方式改革上应重视归纳总结与宏观管理,避免支付方式复杂化;(5)对于医疗机构的横向合并应持审慎态度。

U.S. total health spending and health spending per capita have been the highest in the world and maintained a relatively high increase rate,which pose significant effects on its politics,economy,social development,and people＇s lives.The reasons for the high cost of health care include failure to control key populations＇ health spending and expenses to treat major diseases,high administration cost resulted from a too complicated health system,high human cost,and high price of medical services.To address the problem of high health spending,the U.S.took a lot of measures based on the rationale of restriction,consolidation,or competition.However,none of the measures had lasting effects on health spending in the past four decades.Keeping the U.S.lessons in mind and combing China＇s practical situation,the authors put forward suggestions as follows：（1）China should pay more attention to improve its health system and attach importance to the role of health system in health spending control;（2）In China＇s health care reform,it may not be appropriate to excessively advocate health care marketization and privatization;（3）The government should play a key role in controlling health spending.Incentive mechanisms for insurers and providers should also be established so that they have the ability and willingness to control health spending;（4）The government should attach importance to generalization and administration of the payment method reform so that payment methods will not be too diverse and complicated in the future;（5）The government should be prudent in approving the horizontal consolidation of hospitals.