Thorpe K E
U.S. Department of Health and Human Services.
J Health Polit Policy Law. 1993 Summer;18(2):477-89. doi: 10.1215/03616878-18-2-477.
Most comparisons of the relative effectiveness of cost containment in the Canadian and U.S. health systems trace Canada's greater success to its single-payer approach. However, these studies ignore the substantial variation that exists in hospital and personal health care spending among both the American states and the provinces and territories of Canada. Four American states have adopted all-payer hospital rate setting; one other uses competitive bidding. All five show rates of growth in per capita hospital spending comparable to (and in some cases, lower than) the Canadian jurisdictions. Hospital spending, as a percentage of state gross domestic product (GDP), declined or remained constant in four of the five states. In four out of the five, growth in per capita spending on personal care, as a percentage of GDP, remained or fell below the national average. By contrast, in Canada, per capita spending on both hospitals and personal health care increased as a percentage of GDP in ten out of eleven jurisdictions. In each of the U.S. states, government played a central role in structuring the terms of payment and thus strengthened the hand of purchasers over providers. This strategy, rather than specifically a single-payer or universal health insurance approach, seems to be the key to limiting the growth in health costs to the growth in state or national income.
大多数关于加拿大和美国医疗系统成本控制相对有效性的比较都将加拿大更大的成功归因于其单一支付者模式。然而，这些研究忽略了美国各州以及加拿大各省和地区在医院和个人医疗保健支出方面存在的巨大差异。美国有四个州采用了所有支付者医院费率设定；另一个州采用竞争性投标。所有这五个州的人均医院支出增长率与加拿大各司法管辖区相当（在某些情况下低于加拿大）。在这五个州中，有四个州的医院支出占州国内生产总值（GDP）的百分比下降或保持不变。在这五个州中的四个州，个人护理人均支出占GDP的百分比增长保持或低于全国平均水平。相比之下，在加拿大，在十一个司法管辖区中的十个，医院和个人医疗保健的人均支出占GDP的百分比都有所增加。在美国的每个州，政府在构建支付条款方面都发挥了核心作用，从而增强了购买者相对于提供者的影响力。这种策略，而不是具体的单一支付者或全民健康保险模式，似乎是将医疗成本增长限制在州或国家收入增长范围内的关键。
