Herman Patricia M
RAND Corporation, Santa Monica, California; Samueli Institute, Alexandria, Virginia.
Glob Adv Health Med. 2013 Mar;2(2):56-63. doi: 10.7453/gahmj.2013.002.
Healthcare in the United States is expensive and becoming more so every year. Policy and decision makers increasingly need information on costs, as well as effectiveness and safety, in order to formulate health-care strategies that are both clinically effective and financially responsible. Many people believe the benefits of complementary and integrative medicine (CIM) exceed its costs. Surveys have shown that a substantial portion of the US population uses CIM and pays directly for that use.(1) (-) (4) The most recent estimates show that total US out-of-pocket expenditures for CIM were $34 billion-11% of all US out-of-pocket healthcare expenditures.(1) However, if CIM is to be considered in broader healthcare strategies, its economic impact must be determined. Theoretically, CIM seems a good candidate for cost-effectiveness, and even cost savings, because it avoids high technology, offers inexpensive and noninvasive remedies, encourages healthy lifestyle change, and focuses on the whole person, all of which may improve health beyond the targeted disease or condition. However, to many in the conventional health-care system, CIM is seen only as an "add on" expense. What must be demonstrated via economic evaluation are the healthcare costs that can be avoided through the use of CIM. CIM offers the potential for several avenues of cost reduction. The first is as a direct replacement for the usual conventional therapy for a condition. The second is in terms of lower future healthcare utilization both in general (through treating the whole person) and for the targeted disease or condition. A third avenue to cost reduction is through reducing productivity loss for employers. A reduction in costs to employers does not directly reduce healthcare costs (unless the employer is itself a health-care facility); however, both are costs to society. Productivity losses can be reduced through improved employee health, and potentially through the improved employee well-being and empowerment offered by CIM.
美国的医疗保健费用高昂，且逐年攀升。政策制定者和决策者越来越需要有关成本以及有效性和安全性的信息，以便制定出既具有临床效果又在财务上可行的医疗保健策略。许多人认为补充和整合医学（CIM）的益处超过了其成本。调查显示，美国相当一部分人口使用CIM并直接为此付费。（1）（-）（4）最新估计表明，美国CIM的自付总支出为340亿美元，占美国所有自付医疗保健支出的11%。（1）然而，如果要在更广泛的医疗保健策略中考虑CIM，就必须确定其经济影响。从理论上讲，CIM似乎是成本效益甚至成本节约的理想选择，因为它避免了高科技手段，提供了廉价且无创的治疗方法，鼓励健康的生活方式改变，并关注整个人，所有这些都可能改善健康状况，超出针对的疾病或病症。然而，在传统医疗保健系统中的许多人看来，CIM仅仅被视为一项“额外”费用。必须通过经济评估来证明的是，通过使用CIM可以避免的医疗保健成本。CIM提供了多种降低成本的途径。第一种是直接替代针对某种病症的常规传统疗法。第二种是就总体上（通过治疗整个人）以及针对的疾病或病症而言，降低未来的医疗保健利用率。降低成本的第三条途径是减少雇主的生产力损失。雇主成本的降低并不会直接降低医疗保健成本（除非雇主本身就是医疗保健机构）；然而，两者都是社会成本。通过改善员工健康，以及潜在地通过CIM提供的员工幸福感和自主权的提升，可以减少生产力损失。
