Peden E A, Freeland M S
Office of Strategic Planning, Health Care Financing Administration, Baltimore, MD 21244, USA.
Health Econ. 1998 Dec;7(8):671-87. doi: 10.1002/(sici)1099-1050(199812)7:8<671::aid-hec379>3.0.co;2-9.
Regression results show that nearly half of 1960-1993 growth in real per capita medical spending and almost two-thirds of its 1983-1993 growth were due to ever-increasing levels of insurance coverage (the spending portion paid by third parties). Growth in coverage may have played a minor part as well; we would not rule out the standard finding that it has had a positive but relatively small effect. Viewed from a different perspective, the results imply that about two-thirds of 1960-1993 spending growth came via cost-increasing advances in medical technology resulting from: (1) commercial research and development induced by coverage levels and (2) noncommercial medical research. The remaining one-third, was due to standard factors: age-sex mix changes, income growth and coverage growth (the latter playing a small but indeterminate part).
回归结果显示，1960年至1993年实际人均医疗支出增长的近一半以及1983年至1993年增长的近三分之二，是由于保险覆盖范围（第三方支付的支出部分）不断增加所致。覆盖范围的增长可能也起到了较小的作用；我们不排除有这样一个标准发现，即它产生了积极但相对较小的影响。从另一个角度来看，这些结果意味着，1960年至1993年支出增长的约三分之二是通过医疗技术成本增加的进步实现的，这是由以下因素导致的：（1）由覆盖水平引发的商业研发，以及（2）非商业性医学研究。其余三分之一则归因于标准因素：年龄性别构成变化、收入增长和覆盖范围增长（后者起到了小但不确定的作用）。
