Brandon R M, Podhorzer M, Pollak T H
Citizens Fund, Washington, DC 20036.
Int J Health Serv. 1991;21(2):265-83. doi: 10.2190/H824-R263-YL47-WRQD.
The U.S. system of health insurance is wasteful and inefficient. For every dollar the commercial health insurance industry paid in claims in 1988, the industry spent 33.5 cents for administration, marketing, and other overhead expenses. Thus, not including profits, the commercial insurance industry spent 14 times as much on administration, overhead, and marketing per dollar of claims paid as did the Medicare system, and 11 times as much per dollar of claims paid as the Canadian national health system. Had an efficient public program such as Medicare or the Canadian system provided the same amount of benefits, consumers and businesses served by commercial insurers would have saved $13 billion. The sources of waste include excessive marketing costs and administrative costs bloated by discriminatory underwriting practices that segregate the profitable groups and individuals--people who are healthy, young, and in "safe" professions--from everyone else.
美国的医疗保险体系既浪费又低效。1988年，商业医疗保险行业每赔付1美元，就要花费33.5美分用于行政、营销及其他间接费用。因此，不包括利润在内，商业保险行业每赔付1美元所花费的行政、间接及营销费用是医疗保险体系的14倍，是加拿大国家医疗体系的11倍。如果像医疗保险体系或加拿大体系这样高效的公共项目提供同等水平的福利，那么由商业保险公司服务的消费者和企业本可节省130亿美元。浪费的根源包括过高的营销成本以及因歧视性承保做法而膨胀的行政成本，这种做法将盈利的群体和个人——健康、年轻且从事“安全”职业的人——与其他所有人区分开来。
