Thorpe Kenneth E, Allen Lindsay, Joski Peter
Emory University, Atlanta, GA, USA,
Appl Health Econ Health Policy. 2015 Aug;13(4):381-7. doi: 10.1007/s40258-015-0164-7.
To curb rising healthcare expenditures in the U.S.A., the factors underlying this growth must be well understood.
We aim to explore how chronic disease prevalence, obesity, and improved disease detection and treatment rates contributed to the growth in health spending in the U.S.A. between 1987 and 2011.
We use spending decomposition equations to estimate the portion of spending growth attributable to prevalence increases, rising treatment costs, and population growth, respectively. We use two-part models to estimate the portion of prevalence-related spending that is potentially due to obesity. We examine changing diagnosis and treatment rates to assess how much of the growth in spending might be desirable.
We find that the share of total healthcare spending associated with the treatment of chronic disease has risen dramatically from 1987-2011. In particular, we estimate that 77.6% of healthcare spending growth is attributable to patients with four or more chronic conditions. We find that rising obesity levels may explain between 11.4 and 23.5% of the increase in healthcare expenditure for several specific chronic conditions. Diagnosis and treatment rates for chronic disease are improving.
Individuals with multiple chronic conditions are disproportionately responsible for rising healthcare expenditure. Much of spending growth associated with rising rates of chronic disease can be linked to rising obesity rates. Though much of the growth in spending is generally considered undesirable, disease detection and treatment rates are also rising, suggesting that at least some of the recent growth in healthcare expenditure may be beneficial.
为了遏制美国不断上涨的医疗保健支出，必须充分了解这种增长背后的因素。
我们旨在探讨慢性病患病率、肥胖症以及疾病检测和治疗率的提高如何导致了1987年至2011年间美国医疗支出的增长。
我们使用支出分解方程分别估计支出增长中归因于患病率上升、治疗成本上升和人口增长的部分。我们使用两部分模型来估计与患病率相关的支出中可能归因于肥胖症的部分。我们研究诊断和治疗率的变化，以评估支出增长中有多少可能是合理的。
我们发现，与慢性病治疗相关的医疗保健总支出份额在1987年至2011年间大幅上升。特别是，我们估计77.6%的医疗支出增长归因于患有四种或更多慢性病的患者。我们发现，肥胖水平的上升可能解释了几种特定慢性病医疗支出增加的11.4%至23.5%。慢性病的诊断和治疗率正在提高。
患有多种慢性病的个体对医疗支出的增长负有不成比例的责任。与慢性病发病率上升相关的大部分支出增长可归因于肥胖率的上升。尽管大部分支出增长通常被认为是不合理的，但疾病检测和治疗率也在上升，这表明近期医疗支出的至少一些增长可能是有益的。
