Fishman Paul A, Hornbrook Mark C, Meenan Richard T, Goodman Michael J
Group Health Cooperative, USA.
Med Care Res Rev. 2004 Sep;61(3 Suppl):124S-43S. doi: 10.1177/1077558704267512.
Empirical studies of health care cost, productivity, and output have focused primarily on intermediate goods and services. Consumers are ultimately interested in final goods such as improved health or health-related quality of life, but health services research continues to address whether health services financing and delivery are structured in ways to maximize production of intermediate goods, regardless of the link between these services and final outcomes. Increasing rates of growth of health care cost and dissatisfaction with the quality of U.S. health care force us to reexamine how productivity and cost are analyzed so that research properly informs policy and practice. The authors examine recent changes in the U.S. health care sector that suggest the need to revise how health services research approaches analyses of cost, production, and output; consider alternative notions of final goods; and review the availability and quality of data necessary to conduct this research.
对医疗保健成本、生产率和产出的实证研究主要集中在中间产品和服务上。消费者最终感兴趣的是诸如改善健康状况或与健康相关的生活质量等最终产品，但卫生服务研究仍在探讨卫生服务融资和提供的结构方式是否能使中间产品的产量最大化，而不论这些服务与最终结果之间的联系如何。医疗保健成本的不断增长以及对美国医疗保健质量的不满迫使我们重新审视如何分析生产率和成本，以便研究能为政策和实践提供恰当的信息。作者研究了美国医疗保健部门最近的变化，这些变化表明有必要修订卫生服务研究分析成本、生产和产出的方式；考虑最终产品的替代概念；并审查开展这项研究所需数据的可得性和质量。
