近日，美国华盛顿大学健康指标和评估研究所教授Christopher J. L. Murray及其研究团队，分析了1996-2016年美国不同付款类型和健康状况的医疗保健支出。相关论文于2020年3月3日发表在《美国医学会杂志》上。

美国医疗保健支出持续增长，目前占美国经济的18％，但人们对每种健康状况支出如何因付款类型而变化，以及这些数额如何随时间变化知之甚少。

为了评估1996-2016年美国3种付款类型（公共保险、私人保险或自费），在不同健康状况、年龄、性别和护理类型中的医疗保健支出，研究组收集了1996-2016年间的政府预算、保险索赔、设施记录、家庭调查和美国官方记录，对154种健康状况的支出进行估算，并计算每种付款类型和健康状况的支出增长率。

医疗保健总支出从1996年的约1.4万亿美元（占国内生产总值的13.3％；每人5259美元）增加到2016年的约3.1万亿美元（占国内生产总值的17.9％；每人9655美元）；该研究中包括了85.2％的支出。

2016年的医疗保健支出，估计私人保险支付了48.0%，公共保险支付了42.6％，自费支付了9.4％。2016年，在154种疾病中，下腰部和颈部疼痛的医疗保健支出最高，约为1345亿美元，其中57.2％由私人保险支付，33.7％由公共保险支付，9.2％由个人自费支付。其他肌肉骨骼疾病的医疗保健支出居第二位，约为1298亿美元，56.4%由私人保险支付。糖尿病的医疗保健支出占第三位，约为1112亿美元，49.8%由公共保险支付。

2016年还有大量医疗保健支出的其他健康状况包括缺血性心脏病（893亿美元）、跌倒（874亿美元）、泌尿系统疾病（860亿美元）、皮肤和皮下疾病（850亿美元），骨关节炎（800亿美元），痴呆症（792亿美元）和高血压（790亿美元）。

支出最高的健康状况因付款类型、年龄、性别、护理类型和年份而异。在对通货膨胀、人口规模和年龄组的变化进行校正后，估计公共保险支出的年增长率为2.9％，私人保险为2.6％，自费为1.1％。

总之，从1996年到2016年，美国在医疗保健上的支出大幅增长，其中公共保险在人口调整后支出增长最快。尽管在下背部和颈部疼痛、其他肌肉骨骼疾病和糖尿病上的支出最多，但付款类型和年支出增长率的变化率差异很大。

附：英文原文

Title: US Health Care Spending by Payer and Health Condition, 1996-2016

Author: Joseph L. Dieleman, Jackie Cao, Abby Chapin, Carina Chen, Zhiyin Li, Angela Liu, Cody Horst, Alexander Kaldjian, Taylor Matyasz, Kirstin Woody Scott, Anthony L. Bui, Madeline Campbell, Herbert C. Duber, Abe C. Dunn, Abraham D. Flaxman, Christina Fitzmaurice, Mohsen Naghavi, Nafis Sadat, Peter Shieh, Ellen Squires, Kai Yeung, Christopher J. L. Murray

Issue&Volume: 2020/03/03

Abstract: Importance  US health care spending has continued to increase and now accounts for 18% of the US economy, although little is known about how spending on each health condition varies by payer, and how these amounts have changed over time.Objective  To estimate US spending on health care according to 3 types of payers (public insurance [including Medicare, Medicaid, and other government programs], private insurance, or out-of-pocket payments) and by health condition, age group, sex, and type of care for 1996 through 2016.Design and Setting  Government budgets, insurance claims, facility records, household surveys, and official US records from 1996 through 2016 were collected to estimate spending for 154 health conditions. Spending growth rates (standardized by population size and age group) were calculated for each type of payer and health condition.Exposures  Ambulatory care, inpatient care, nursing care facility stay, emergency department care, dental care, and purchase of prescribed pharmaceuticals in a retail setting.Main Outcomes and Measures  National spending estimates stratified by health condition, age group, sex, type of care, and type of payer and modeled for each year from 1996 through 2016.Results  Total health care spending increased from an estimated $1.4 trillion in 1996 (13.3% of gross domestic product [GDP]; $5259 per person) to an estimated $3.1 trillion in 2016 (17.9% of GDP; $9655 per person); 85.2% of that spending was included in this study. In 2016, an estimated 48.0% (95% CI, 48.0%-48.0%) of health care spending was paid by private insurance, 42.6% (95% CI, 42.5%-42.6%) by public insurance, and 9.4% (95% CI, 9.4%-9.4%) by out-of-pocket payments. In 2016, among the 154 conditions, low back and neck pain had the highest amount of health care spending with an estimated $134.5 billion (95% CI, $122.4-$146.9 billion) in spending, of which 57.2% (95% CI, 52.2%-61.2%) was paid by private insurance, 33.7% (95% CI, 30.0%-38.4%) by public insurance, and 9.2% (95% CI, 8.3%-10.4%) by out-of-pocket payments. Other musculoskeletal disorders accounted for the second highest amount of health care spending (estimated at $129.8 billion [95% CI, $116.3-$149.7 billion]) and most had private insurance (56.4% [95% CI, 52.6%-59.3%]). Diabetes accounted for the third highest amount of the health care spending (estimated at $111.2 billion [95% CI, $105.7-$115.9 billion]) and most had public insurance (49.8% [95% CI, 44.4%-56.0%]). Other conditions estimated to have substantial health care spending in 2016 were ischemic heart disease ($89.3 billion [95% CI, $81.1-$95.5 billion]), falls ($87.4 billion [95% CI, $75.0-$100.1 billion]), urinary diseases ($86.0 billion [95% CI, $76.3-$95.9 billion]), skin and subcutaneous diseases ($85.0 billion [95% CI, $80.5-$90.2 billion]), osteoarthritis ($80.0 billion [95% CI, $72.2-$86.1 billion]), dementias ($79.2 billion [95% CI, $67.6-$90.8 billion]), and hypertension ($79.0 billion [95% CI, $72.6-$86.8 billion]). The conditions with the highest spending varied by type of payer, age, sex, type of care, and year. After adjusting for changes in inflation, population size, and age groups, public insurance spending was estimated to have increased at an annualized rate of 2.9% (95% CI, 2.9%-2.9%); private insurance, 2.6% (95% CI, 2.6%-2.6%); and out-of-pocket payments, 1.1% (95% CI, 1.0%-1.1%).Conclusions and Relevance  Estimates of US spending on health care showed substantial increases from 1996 through 2016, with the highest increases in population-adjusted spending by public insurance. Although spending on low back and neck pain, other musculoskeletal disorders, and diabetes accounted for the highest amounts of spending, the payers and the rates of change in annual spending growth rates varied considerably.

DOI: 10.1001/jama.2020.0734

Source: https://jamanetwork.com/journals/jama/article-abstract/2762309