Evans Robert G
Healthc Policy. 2009 Nov;5(2):14-24.
On June 1, 2009 the town of McAllen, Texas rose to brief prominence on the American political stage. With the highest (bar Miami) per-beneficiary costs in the entire US Medicare program, it was featured in an essay in The New Yorker by Atul Gawande, then seized upon by President Obama: "This is what we have to fix." Behind the headlines were decades of documentation of clinical practice and analysis of regional variations by John Wennberg, Elliott Fisher and their colleagues, and by Leslie and Noralou Roos and theirs. The implications for health systems were grasped over 30 years ago and have been confirmed by more recent work. Efforts to understand these variations within standard economic theory have, however, had limited success.
2009年6月1日，得克萨斯州的麦卡伦镇在美国政治舞台上短暂地崭露头角。在整个美国医疗保险计划中，其每位受益人的成本（迈阿密除外）最高，阿图尔·加万德在《纽约客》上发表的一篇文章中对其进行了专题报道，随后被奥巴马总统抓住：“这就是我们必须解决的问题。”在这些头条新闻背后，是约翰·温伯格、埃利奥特·费舍尔及其同事，以及莱斯利和诺拉卢·鲁斯及其同事数十年的临床实践记录和区域差异分析。30多年前人们就已经认识到了这些差异对卫生系统的影响，最近的研究也证实了这一点。然而，在标准经济理论框架内理解这些差异的努力取得的成功有限。
