J. Mac McCullough and Matthew Speer are with the College of Health Solutions, Arizona State University, Phoenix. Sanne Magnan is with the Health Partners Institute, Minneapolis, MN, and the Department of Medicine, University of Minnesota, Minneapolis. Jonathan E. Fielding and Steven M. Teutsch are with the Center for Health Advancement, Fielding School of Public Health, University of California, Los Angeles. David Kindig is with the Population Health Institute, University of Wisconsin School of Medicine and Public Health, Madison.
Am J Public Health. 2020 Dec;110(12):1735-1740. doi: 10.2105/AJPH.2020.305793. Epub 2020 Oct 15.
To quantify changes in US health care spending required to reach parity with high-resource nations by 2030 or 2040 and identify historical precedents for these changes. We analyzed multiple sources of historical and projected spending from 1970 through 2040. Parity was defined as the Organisation for Economic Co-operation and Development (OECD) median or 90th percentile for per capita health care spending. Sustained annual declines of 7.0% and 3.3% would be required to reach the median of other high-resource nations by 2030 and 2040, respectively (3.2% and 1.3% to reach the 90th percentile). Such declines do not have historical precedent among US states or OECD nations. Traditional approaches to reducing health care spending will not enable the United States to achieve parity with high-resource nations; strategies to eliminate waste and reduce the demand for health care are essential. Excess spending reduces the ability of the United States to meet critical public health needs and affects the country's economic competitiveness. Rising health care spending has been identified as a threat to the nation's health. Public health can add voices, leadership, and expertise for reversing this course.
为了量化 2030 年或 2040 年实现与高资源国家平价所需的美国医疗保健支出变化，并为这些变化找到历史先例。我们分析了 1970 年至 2040 年期间多个来源的历史和预测支出。平价定义为经济合作与发展组织（经合组织）中位数或人均医疗保健支出的第 90 个百分位。要在 2030 年和 2040 年分别达到其他高资源国家的中位数（达到第 90 个百分位则分别需要 3.2%和 1.3%），则需要持续每年下降 7.0%和 3.3%。美国各州或经合组织国家都没有这种下降的历史先例。减少医疗保健支出的传统方法将使美国无法与高资源国家实现平价；消除浪费和减少医疗保健需求的策略至关重要。过度支出降低了美国满足关键公共卫生需求的能力，并影响了该国的经济竞争力。不断上升的医疗保健支出已被确定为威胁国家健康的因素。公共卫生可以为扭转这一局面增添声音、领导力和专业知识。
