Bentley Tanya G K, Effros Rachel M, Palar Kartika, Keeler Emmett B
RAND Corporation, Santa Monica, CA 90407-2138, USA.
Milbank Q. 2008 Dec;86(4):629-59. doi: 10.1111/j.1468-0009.2008.00537.x.
Health care costs in the United States are much higher than those in industrial countries with similar or better health system performance. Wasteful spending has many undesirable consequences that could be alleviated through waste reduction. This article proposes a conceptual framework to guide researchers and policymakers in evaluating waste, implementing waste-reduction strategies, and reducing the burden of unnecessary health care spending.
This article divides health care waste into administrative, operational, and clinical waste and provides an overview of each. It explains how researchers have used both high-level and sector- or procedure-specific comparisons to quantify such waste, and it discusses examples and challenges in both waste measurement and waste reduction.
Waste is caused by factors such as health insurance and medical uncertainties that encourage the production of inefficient and low-value services. Various efforts to reduce such waste have encountered challenges, such as the high costs of initial investment, unintended administrative complexities, and trade-offs among patients', payers', and providers' interests. While categorizing waste may help identify and measure general types and sources of waste, successful reduction strategies must integrate the administrative, operational, and clinical components of care, and proceed by identifying goals, changing systemic incentives, and making specific process improvements.
Classifying, identifying, and measuring waste elucidate its causes, clarify systemic goals, and specify potential health care reforms that-by improving the market for health insurance and health care-will generate incentives for better efficiency and thus ultimately decrease waste in the U.S. health care system.
美国的医疗保健成本远高于医疗系统表现相似或更好的工业化国家。浪费性支出会产生许多不良后果，通过减少浪费可以缓解这些后果。本文提出了一个概念框架，以指导研究人员和政策制定者评估浪费情况、实施减少浪费的策略以及减轻不必要的医疗保健支出负担。
本文将医疗保健浪费分为行政浪费、运营浪费和临床浪费，并对每一种进行了概述。它解释了研究人员如何利用高层次以及特定部门或程序的比较来量化此类浪费，并讨论了浪费测量和减少浪费方面的实例和挑战。
浪费是由医疗保险和医疗不确定性等因素造成的，这些因素助长了低效和低价值服务的产生。减少此类浪费的各种努力都遇到了挑战，比如初始投资成本高昂、意外的行政复杂性以及患者、支付方和提供者利益之间的权衡。虽然对浪费进行分类可能有助于识别和衡量一般类型及浪费来源，但成功的减少浪费策略必须整合医疗保健的行政、运营和临床组成部分，并通过确定目标、改变系统激励措施以及进行具体的流程改进来推进。
对浪费进行分类、识别和测量可以阐明其成因、明确系统目标，并具体指出潜在的医疗保健改革措施，这些改革措施通过改善医疗保险和医疗保健市场，将产生提高效率的激励措施，从而最终减少美国医疗保健系统中的浪费。
