Davis Matthew A, Weeks William B
The Dartmouth Institute for Health Policy, Lebanon, NH, USA.
Altern Ther Health Med. 2012 Sep-Oct;18(5):36-42.
The most intense spenders on health services are considerably less healthy.49% report fair or poor health status compared to 15% of the general adult population and are elderly. Such findings have important implications for addressing national health-care spending because interventions targeting those people who are in poor health could theoretically generate dramatic cost savings. Although the popularity of complementary and alternative medicine (CAM) in the United States is well recognized, little is known about the distribution of out-of-pocket expenditures on CAM services.
This study examined the distribution of out-of-pocket expenditures on CAM health services in the United States.
The research team used data from the 2007 National Health Interview Survey to examine the distribution in the United States of out-of-pocket expenditures on CAM services and the characteristics of adult (age ≥ 18 years) CAM users (n = 2972) according to spending.
Using complex survey-design methods, the research team generated national estimates of expenditures on CAM services and used linear regression adjusted for covariates to determine whether self-reported health status predicted CAM spending.
According to our estimates, in 2007, over 30 million adults reported out-of-pocket expenditures on CAM services, and of these individuals, 7.2 million were heavy CAM spenders with a mean annual expenditure of $1385. The highest quartile of CAM spenders accounted for $10 billion of the $13.9 billion spent nationally on CAM in 2007. Self-reported health status did not differ among groups with differing levels of CAM spending, β = 1.00 (95% CI, 0.8-1.2).
Out-of-pocket spending on CAM is concentrated. Just a quarter of CAM users account for over 70% of all expenditures on CAM services, and health status does not appear to be associated with level of CAM spending.
医疗服务支出最多的人群健康状况相当差。49%的人报告健康状况为一般或较差，相比之下，普通成年人口中这一比例为15%，且这些人年龄较大。这些发现对于解决国家医疗保健支出具有重要意义，因为针对健康状况不佳人群的干预措施理论上可以大幅节省成本。尽管补充和替代医学（CAM）在美国很受欢迎，但对于CAM服务的自付费用分布情况却知之甚少。
本研究调查了美国CAM健康服务的自付费用分布情况。
研究团队使用了2007年全国健康访谈调查的数据，以研究美国CAM服务自付费用的分布情况，以及根据支出情况划分的成年（年龄≥18岁）CAM使用者（n = 2972）的特征。
研究团队采用复杂的调查设计方法，得出了CAM服务支出的全国估计数，并使用经协变量调整的线性回归来确定自我报告的健康状况是否能预测CAM支出。
根据我们的估计，2007年，超过3000万成年人报告有CAM服务的自付费用，其中720万是CAM高支出者，平均年支出为1385美元。2007年，CAM高支出者的最高四分位数占全国139亿美元CAM支出中的100亿美元。不同CAM支出水平的组之间，自我报告的健康状况没有差异，β = 1.00（95%CI，0.8 - 1.2）。
CAM的自付费用集中。仅四分之一的CAM使用者就占了所有CAM服务支出的70%以上，而且健康状况似乎与CAM支出水平无关。
