University of Illinois, Chicago, IL 60614, USA.
Milbank Q. 2010 Dec;88(4):560-94. doi: 10.1111/j.1468-0009.2010.00612.x.
It is widely believed that a significant amount, perhaps as much as 20 to 30 percent, of health care spending in the United States is wasted, despite market forces such as managed care organizations and large, self-insured firms with a financial incentive to eliminate waste of this magnitude.
This article uses Medicare claims data to study the association between inpatient spending and the thirty-day mortality of Medicare patients admitted to hospitals between 2001 and 2005 for surgery (general, orthopedic, vascular) and medical conditions (acute myocardial infarction [AMI], congestive heart failure [CHF], stroke, and gastrointestinal bleeding).
Estimates from the analysis indicated that except for AMI patients, a 10 percent increase in inpatient spending was associated with a decrease of between 3.1 and 11.3 percent in thirty-day mortality, depending on the type of patient.
Although some spending may be inefficient, the results suggest that the amount of waste is less than conventionally believed, at least for inpatient care.
尽管市场力量（如管理式医疗组织和大型、自保的公司，它们有消除这种规模浪费的经济动机），但人们普遍认为，美国的医疗保健支出有很大一部分（也许高达 20%至 30%）被浪费了。
本文使用医疗保险索赔数据，研究了 2001 年至 2005 年间接受手术（普通、骨科、血管）和医疗条件（急性心肌梗死 [AMI]、充血性心力衰竭 [CHF]、中风和胃肠道出血）治疗的医疗保险患者的住院支出与 30 天死亡率之间的关系。
分析的估计结果表明，除 AMI 患者外，住院支出增加 10%与 30 天死亡率降低 3.1%至 11.3%之间存在关联，具体取决于患者类型。
尽管一些支出可能效率低下，但结果表明，浪费的数量低于传统观念，至少对于住院治疗而言是如此。
