Foley J
EBRI Issue Brief. 1993 Oct(142):1-31.
This Issue Brief discusses factors that contribute to the growth of health care expenditures and the reasons that many individuals, employers, and policymakers consider health expenditures too high. In addition, it describes various industries that make up the health care delivery system and their role in the U.S. economy as employers, producers, exporters, and suppliers of research and development. The report also discusses the economic implications of rising health care expenditures for individuals, employers, and the federal government and the potential impact of proposed health care reform on the health care sector and the U.S. economy as a whole. Health care delivery industries such as pharmaceuticals and medical equipment suppliers have higher than average research and development levels, in addition to a positive balance of trade. Moreover, while the total number of jobs in the private sector declined between 1990 and 1993, the number of jobs in the relatively high paid health services sector continued to grow. In aggregate, employer spending on health care represents only 6.6 percent of total labor costs. In comparison, wages and salaries represent 83 percent of total labor costs. Consequently, the growth rate of health care expenditures has a smaller impact on the growth rate of total compensation than does the growth rate in wages and salaries. Using job multipliers developed by the U.S. Department of Commerce, it is estimated that the 18,600 health care services jobs in Rochester, Minnesota in 1993 created another 32,000 jobs in the area. Any contraction of the health care sector in cities that have a large concentration of employment in health services would result in reduced employment in restaurants, retail stores, janitorial services, and other local businesses. EBRI's simulations estimated that between 200,000 and 1.2 million workers could become unemployed as a direct result of a mandate that employers provide health benefits to their employees, assuming that wages and salaries did not adjust at all. Others find that approximately 50,000 individuals would lost their jobs, assuming that wages and other labor costs adjust downward to completely account for increased costs. As is apparent, the estimates of job loss (and of the total costs of the policy) are extremely sensitive to the assumptions used in the simulation.
本问题简报讨论了导致医疗保健支出增长的因素，以及许多个人、雇主和政策制定者认为医疗支出过高的原因。此外，它描述了构成医疗保健服务体系的各个行业，以及它们在美国经济中作为雇主、生产者、出口商和研发供应商所扮演的角色。该报告还讨论了医疗保健支出上升对个人、雇主和联邦政府的经济影响，以及拟议的医疗保健改革对医疗保健部门和整个美国经济的潜在影响。制药和医疗设备供应商等医疗保健服务行业除了贸易顺差外，研发水平也高于平均水平。此外，虽然1990年至1993年期间私营部门的就业总数有所下降，但相对高薪的医疗服务部门的就业人数仍在继续增长。总体而言，雇主在医疗保健方面的支出仅占劳动力总成本的6.6%。相比之下，工资和薪金占劳动力总成本的83%。因此，医疗保健支出的增长率对总薪酬增长率的影响要小于工资和薪金的增长率。根据美国商务部制定的就业乘数估计，1993年明尼苏达州罗切斯特市的18600个医疗保健服务岗位在该地区又创造了32000个就业机会。在医疗服务就业高度集中的城市，医疗保健部门的任何收缩都将导致餐馆、零售店、清洁服务和其他当地企业的就业减少。员工福利研究协会（EBRI）的模拟估计，假设工资和薪金完全不调整，强制雇主为其员工提供健康福利可能会直接导致20万至120万工人失业。其他人则发现，假设工资和其他劳动力成本向下调整以完全抵消成本增加，大约5万人将失去工作。显而易见，失业估计数（以及政策的总成本）对模拟中使用的假设极为敏感。
