David M. Cutler (
Health Aff (Millwood). 2018 Mar;37(3):493-497. doi: 10.1377/hlthaff.2017.1626. Epub 2018 Feb 14.
Is increased spending on medical care harmful to the US economy? The overall share of the gross domestic product spent on medical care is not a problem, provided that the services bought are worth more than their cost. However, high and rising costs expose two often-overlooked problems. First, spending is too high because many dollars are wasted. Estimates suggest that unnecessary medical spending costs the typical American family thousands of dollars each year. Second, high medical costs combined with stagnant incomes for a large share of the population and the inability of governments at all levels to raise tax dollars leads to increased health and economic disparities: fewer people covered by private insurance, the rationing of care in public health programs, and the lack of funds for other social programs. These distribution issues, coupled with the large waste, imply that efforts to address medical spending need to be among our highest priorities.
医疗保健支出的增加对美国经济有害吗？只要购买的服务物有所值，医疗保健支出占国内生产总值的总体份额就不是问题。然而，居高不下且不断上升的成本暴露出两个常常被忽视的问题。首先，支出过高是因为有很多钱被浪费了。据估计，不必要的医疗支出每年使每个美国家庭损失数千美元。其次，医疗成本高加上很大一部分人口的收入停滞不前，以及各级政府无法增加税收，导致健康和经济差距加大：私人保险覆盖的人群减少，公共卫生计划中的医疗服务配给，以及其他社会项目缺乏资金。这些分配问题，加上大量的浪费，意味着解决医疗支出问题需要成为我们的首要任务之一。
