Kanavos P, Mossialos E
Department of Social Policy & Administration and LSE Health, London School of Economics and Political Science, London, UK.
J Health Serv Res Policy. 1999 Apr;4(2):122-6. doi: 10.1177/135581969900400211.
International comparisons of health care expenditures and their determinants have attracted considerable attention since the early 1960s and have since been used widely to compare countries. The impetus for this has been two-fold: firstly, to assess the macroeconomic efficiency of health systems by determining whether different methods of financing and delivering health care have contributed to the control of overall spending levels; and, secondly, to investigate the determinants of the level of health care expenditure. Empirical research has suggested that there is a causal and statistically significant relationship between growth in health spending and growth in gross domestic product (GDP), and that an increase in the latter brings about a proportionately larger increase in the former. This relationship holds even when other potential determinants, such as urbanisation and age structure of the population, are included in the analysis, leading to the conclusion that health care is a luxury good. This paper examines the extent to which this finding is valid from a methodological perspective and how far it assists policy analysis. We argue that there are significant problems in the measurement of health spending and GDP, discuss the methodological problems in the analysis and suggest that the observed relationship between GDP and health spending is unhelpful and almost certainly misleading for health policy development.
自20世纪60年代初以来，医疗保健支出及其决定因素的国际比较就备受关注，此后被广泛用于比较各国情况。这样做的动力有两方面：其一，通过确定不同的医疗保健融资和提供方式是否有助于控制总体支出水平，来评估卫生系统的宏观经济效率；其二，调查医疗保健支出水平的决定因素。实证研究表明，卫生支出增长与国内生产总值（GDP）增长之间存在因果关系且具有统计学意义，而且后者的增长会使前者出现更大比例的增长。即使在分析中纳入其他潜在决定因素，如城市化和人口年龄结构，这种关系依然成立，从而得出医疗保健是奢侈品的结论。本文从方法论角度审视这一发现的有效程度，以及它在多大程度上有助于政策分析。我们认为，在卫生支出和GDP的衡量方面存在重大问题，讨论了分析中的方法论问题，并指出观察到的GDP与卫生支出之间的关系对卫生政策制定并无帮助，而且几乎肯定会产生误导。
