Hensher Martin, Canny Ben, Zimitat Craig, Campbell Julie, Palmer Andrew
Deakin Health Economics, Deakin University, BC3, 221 Burwood Highway, Burwood, VIC, 3125, Australia; Menzies Institute for Medical Research, University of Tasmania, Medical Science 1, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
School of Medicine, University of Tasmania, Medical Science 1, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
Soc Sci Med. 2020 Dec;266:113420. doi: 10.1016/j.socscimed.2020.113420. Epub 2020 Oct 9.
Concerns have grown in recent decades that economic growth in many rich countries may, in fact, be uneconomic. Uneconomic growth occurs when expansion in economic activity causes environmental and social costs that are greater than the benefits of that additional activity. Health care has enjoyed a close historical relationship with economic growth, with health care spending consistently growing faster than GDP over the long term. This paper explores the possible relationship between health care and uneconomic growth. It summarises the rapidly growing evidence on the harms caused by poor quality health care and by the overuse of health care, and on the environmental harms caused by health care systems. Further, it develops a conceptual framework for considering the overconsumption of health care and the joint harms to human health and the natural environment that ensue. This framework illustrates how health-damaging overconsumption in the wider economy combines with unnecessary or low-quality health care to create a cycle of "failure demand" and defensive expenditure on health care services. Health care therefore provides important sectoral insights on the phenomenon of uneconomic growth. There are rich opportunities for interdisciplinary research to quantify the joint harms of overconsumption in health and health care, and to estimate the optimal scale of the health sector from novel perspectives that prioritise human and planetary health and well-being over GDP and profit.
近几十年来，人们越来越担心许多富裕国家的经济增长实际上可能是不经济的。当经济活动的扩张导致环境和社会成本大于该额外活动的收益时，就会出现不经济增长。医疗保健与经济增长在历史上有着密切的关系，长期来看，医疗保健支出的增长速度一直快于国内生产总值。本文探讨了医疗保健与不经济增长之间可能存在的关系。它总结了关于低质量医疗保健和医疗保健过度使用所造成危害以及医疗保健系统对环境造成危害的迅速增加的证据。此外，它还建立了一个概念框架，用于思考医疗保健的过度消费以及随之而来的对人类健康和自然环境的共同危害。这个框架说明了更广泛经济中损害健康的过度消费如何与不必要或低质量的医疗保健相结合，从而形成一个“失败需求”和医疗保健服务防御性支出的循环。因此，医疗保健为不经济增长现象提供了重要的部门见解。跨学科研究有丰富的机会来量化健康和医疗保健过度消费的共同危害，并从优先考虑人类和地球健康与福祉而非国内生产总值和利润的新视角估计医疗部门的最佳规模。
