Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.
International Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria; Wittgenstein Centre (IIASA, OeAW, University of Vienna), Vienna Institute of Demography, Vienna, Austria.
Soc Sci Med. 2021 Oct;287:114270. doi: 10.1016/j.socscimed.2021.114270. Epub 2021 Jul 24.
The coronavirus disease 2019 (COVID-19) pandemic highlights the importance of strong and resilient health systems. Yet how much a society should spend on healthcare is difficult to determine because additional health expenditures imply lower expenditures on other types of consumption. Furthermore, the welfare-maximizing ("efficient") aggregate amount and composition of health expenditures depend on efficiency concepts at three levels that often get blurred in the debate. While the understanding of efficiency is good at the micro- and meso-levels-that is, relating to minimal spending for a given bundle of treatments and to the optimal mix of different treatments, respectively-this understanding rarely links to the efficiency of aggregate health expenditure at the macroeconomic level. While micro- and meso-efficiency are necessary for macro-efficiency, they are not sufficient. We propose a novel framework of a macro-efficiency score to assess welfare-maximizing aggregate health expenditure. This allows us to assess the extent to which selected major economies underspend or overspend on health relative to their gross domestic products per capita. We find that all economies under consideration underspend on healthcare with the exception of the United States. Underspending is particularly severe in China, India, and the Russian Federation. Our study emphasizes that the major and urgent issue in many countries is underspending on health at the macroeconomic level, rather than containing costs at the microeconomic level.
2019 年冠状病毒病（COVID-19）大流行凸显了强大和有弹性的卫生系统的重要性。然而，一个社会应该在医疗保健上花费多少是很难确定的，因为额外的医疗支出意味着其他类型的消费支出减少。此外，福利最大化（“有效”）的总医疗支出金额和构成取决于三个层面的效率概念，这些概念在辩论中经常混淆。虽然对微观和中观层面的效率理解较好，即与给定治疗方案包的最小支出和不同治疗方案的最佳组合分别相关，但这种理解很少与宏观经济层面的总医疗支出效率相关。虽然微观和中观效率对于宏观效率是必要的，但它们并不充分。我们提出了一个新的宏观效率评分框架，以评估福利最大化的总医疗支出。这使我们能够评估选定的主要经济体相对于其人均国内生产总值在医疗保健方面的支出不足或过度支出的程度。我们发现，除了美国，所有被考虑的经济体在医疗保健方面的支出都不足。中国、印度和俄罗斯联邦的支出不足尤为严重。我们的研究强调，在许多国家，主要和紧迫的问题是宏观经济层面的医疗支出不足，而不是微观经济层面的成本控制。
