De Nardi Mariacristina, French Eric, Jones John Bailey, McCauley Jeremy
University College London; Federal Reserve Bank of Chicago; Institute for Fiscal Studies; National Bureau of Economic Research.
University College London; Centre for Economic Policy Research (CEPR); Institute for Fiscal Studies.
Fisc Stud. 2016 Sep-Dec;37(3-4):717-747. doi: 10.1111/j.1475-5890.2016.12106. Epub 2016 Nov 21.
We use data from the Medicare Current Beneficiary Survey (MCBS) to document the medical spending of Americans aged 65 and older. We find that medical expenses more than double between ages 70 and 90 and that they are very concentrated: the top 10 per cent of all spenders are responsible for 52 per cent of medical spending in a given year. In addition, those currently experiencing either very low or very high medical expenses are likely to find themselves in the same position in the future. We also find that the poor consume more medical goods and services than the rich and have a much larger share of their expenses covered by the government. Overall, the government pays for over 65 per cent of the elderly's medical expenses. Despite this, the expenses that remain after government transfers are even more concentrated among a small group of people. Thus, government health insurance, while potentially very valuable, is far from complete. Finally, while medical expenses before death can be large, on average they constitute only a small fraction of total spending, both in the aggregate and over the life cycle. Hence, medical expenses before death do not appear to be an important driver of the high and increasing medical spending found in the US.
我们使用来自医疗保险当前受益人调查（MCBS）的数据来记录65岁及以上美国人的医疗支出情况。我们发现，70岁至90岁之间的医疗费用增加了一倍多，而且这些费用高度集中：在某一年中，所有支出最高的10%的人群承担了52%的医疗支出。此外，目前医疗费用极低或极高的人群未来很可能仍处于同样的状况。我们还发现，穷人比富人消费更多的医疗商品和服务，且他们的费用中有更大比例由政府承担。总体而言，政府支付了老年人超过65%的医疗费用。尽管如此，政府转移支付后剩余的费用在一小部分人群中更加集中。因此，政府医疗保险虽然可能非常有价值，但远远不够完善。最后，虽然临终前的医疗费用可能很高，但平均而言，无论是在总体上还是在生命周期内，它们仅占总支出的一小部分。因此，临终前的医疗费用似乎并不是美国医疗支出居高不下且不断增加的重要驱动因素。
