Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
Annu Rev Public Health. 2012 Apr;33:409-23. doi: 10.1146/annurev-publhealth-031811-124652. Epub 2012 Jan 3.
U.S. health care spending has increased dramatically in the past several decades, consuming 17.6% percent ($2.6 trillion) of GDP in 2010. Although historical spending drivers do not account for this recent increase, two major changes in population health--the rise in obesity and obesity-related chronic disease--provide a likely explanation. This article reviews the contribution that rising treated obesity-related chronic disease prevalence and its associated treatment (spending per treated case) has made to the growth in health care spending. We discuss trends in the clinical incidence of obesity and chronic disease as well as timely advancements in disease detection, treatment, and management. Evidence shows that rising obesity rates are influencing spending largely by increasing the treated prevalence of obesity-related chronic disease. Therefore, preventing individuals from becoming treated cases in the first place is one key way that our country can cut health care spending moving forward.
在过去几十年中，美国的医疗保健支出大幅增长，2010 年占 GDP 的 17.6%（2.6 万亿美元）。尽管历史支出驱动因素不能解释最近的这种增长，但人口健康的两个重大变化——肥胖率的上升和与肥胖相关的慢性疾病——提供了一个可能的解释。本文回顾了治疗肥胖相关慢性疾病的患病率上升及其相关治疗（每个治疗病例的支出）对医疗保健支出增长的贡献。我们讨论了肥胖和慢性疾病的临床发病率的趋势，以及疾病检测、治疗和管理方面的及时进展。有证据表明，肥胖率的上升主要是通过增加与肥胖相关的慢性疾病的治疗患病率来影响支出。因此，防止人们首先成为治疗病例是我国今后降低医疗保健支出的一个关键途径。
