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过度医疗支出:美国浪费性支出的类别、规模和机会成本。

Excess Medical Care Spending: The Categories, Magnitude, and Opportunity Costs of Wasteful Spending in the United States.

机构信息

Matthew Speer and J. Mac McCullough are with the College of Health Solutions, Arizona State University, Phoenix. Jonathan E. Fielding, Elinore Faustino, and Steven M. Teutsch are with the Center for Health Advancement, University of California, Los Angeles Fielding School of Public Health.

出版信息

Am J Public Health. 2020 Dec;110(12):1743-1748. doi: 10.2105/AJPH.2020.305865. Epub 2020 Oct 15.

Abstract

Landmark reports from reputable sources have concluded that the United States wastes hundreds of billions of dollars every year on medical care that does not improve health outcomes. While there is widespread agreement over how wasteful medical care spending is defined, there is no consensus on its magnitude or categories. A shared understanding of the magnitude and components of the issue may aid in systematically reducing wasteful spending and creating opportunities for these funds to improve public health.To this end, we performed a review and crosswalk analysis of the literature to retrieve comprehensive estimates of wasteful medical care spending. We abstracted each source's definitions, categories of waste, and associated dollar amounts. We synthesized and reclassified waste into 6 categories: clinical inefficiencies, missed prevention opportunities, overuse, administrative waste, excessive prices, and fraud and abuse.Aggregate estimates of waste varied from $600 billion to more than $1.9 trillion per year, or roughly $1800 to $5700 per person per year. Wider recognition by public health stakeholders of the human and economic costs of medical waste has the potential to catalyze health system transformation.

摘要

有可靠来源的里程碑式报告得出结论,美国每年在医疗保健上浪费数百亿美元,而这些支出并不能改善健康结果。尽管人们普遍认为医疗保健支出的浪费程度是如何定义的,但对于其规模或类别并没有共识。对问题的规模和组成部分有一个共同的认识,可能有助于系统地减少浪费性支出,并为这些资金改善公共卫生创造机会。为此,我们对文献进行了回顾和交叉分析,以检索关于浪费性医疗保健支出的综合估计。我们摘录了每个来源的定义、浪费类别和相关金额。我们将浪费综合并重新分类为 6 类:临床效率低下、预防机会错失、过度使用、行政浪费、过高价格以及欺诈和滥用。每年浪费的总估计数在 6000 亿美元至 1.9 万亿美元之间,或每人每年 1800 美元至 5700 美元不等。公共卫生利益相关者更广泛地认识到医疗浪费的人力和经济成本,有可能推动卫生系统转型。

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