Department of Economics, Kenyon College, Gambier, OH 43022, USA.
Soc Sci Med. 2010 Jan;70(2):191-8. doi: 10.1016/j.socscimed.2009.09.018. Epub 2009 Oct 21.
The U.S. autopsy rate has fallen precipitously since the 1940s, decreasing from 50 percent of bodies to less than eight percent today. Much of the decrease occurred after 1971 when hospitals were no longer required to do a minimum number of autopsies for accreditation. Since this time, major changes in the health care sector have occurred in the United States, highlighted by the increased importance of managed care. Using data for 46 states from 1987 to 2000, we analyze the degree to which the rise in manage care explains the decrease in the autopsy rate. We find that increases in health maintenance organization market share explain 21 percent of the decrease in the autopsy rate over the years from 1987 to 2000 and reductions in the number of hospital deaths explain another 30 percent. In contrast, we find that increases in the availability of magnetic resonance imaging had no significant effect on autopsy rates when other factors are held constant. Reforming health care financing to restrain the growth in health care costs using incentive mechanisms similar to those employed by managed care organizations has been a recurring policy goal in the United States. Our results imply that these reforms may inadvertently reduce the incentive to monitor medical outcomes using techniques such as autopsies, which is often called the "gold standard" in measuring medical outcomes.
自 20 世纪 40 年代以来，美国的尸检率急剧下降，从尸检率为 50%降至如今的不足 8%。大部分下降发生在 1971 年之后，当时医院不再需要为获得认证而进行最低数量的尸检。自那时以来，美国医疗保健领域发生了重大变化，以管理式医疗的重要性日益增加为特点。我们利用 1987 年至 2000 年来自 46 个州的数据，分析管理式医疗的增加在多大程度上解释了尸检率的下降。我们发现，健康维护组织市场份额的增加解释了 1987 年至 2000 年期间尸检率下降的 21%，而医院死亡人数的减少又解释了另外的 30%。相比之下，我们发现，在其他因素保持不变的情况下，磁共振成像可用性的增加对尸检率没有显著影响。用类似于管理式医疗组织所采用的激励机制来改革医疗保健融资以遏制医疗保健成本的增长，一直是美国反复出现的政策目标。我们的研究结果表明，这些改革可能会无意中减少使用尸检等技术来监测医疗结果的动力，尸检通常被称为衡量医疗结果的“金标准”。
