US Spending on Personal Health Care and Public Health, 1996-2013.
US Spending on Personal Health Care and Public Health, 1996-2013.
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DOI：
10.1001/jama.2016.16885
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发表时间：
2016-12-27
期刊：
影响因子：
--
通讯作者：
Murray CJ
中科院分区：
文献类型：
--
作者：
Dieleman JL;Baral R;Birger M;Bui AL;Bulchis A;Chapin A;Hamavid H;Horst C;Johnson EK;Joseph J;Lavado R;Lomsadze L;Reynolds A;Squires E;Campbell M;DeCenso B;Dicker D;Flaxman AD;Gabert R;Highfill T;Naghavi M;Nightingale N;Templin T;Tobias MI;Vos T;Murray CJ
美国医疗保健支出持续增加，目前占美国经济的17%以上。尽管这种支出的规模和增长，但人们对每种疾病的支出如何随年龄和时间而变化知之甚少。系统和全面地估计美国在个人卫生保健和公共卫生方面的支出，根据条件，年龄和性别组，以及护理类型。收集并合并了1996年至2013年的政府预算、保险索赔、设施调查、家庭调查和美国官方记录。总共使用了183个数据来源来估计155种疾病的支出（包括癌症，癌症被分解为29种疾病）。对于每一个记录，支出被提取出来，沿着病人的年龄和性别，以及护理的类型。对支出进行了调整，以反映所治疗的健康状况，而不是初步诊断。与美国的医疗保健系统相遇。按条件、年龄和性别组以及护理类型划分的国家支出估计数。从1996年到2013年，30.1万亿美元的个人医疗保健支出按155种条件、年龄和性别组以及护理类型分列。在这155种疾病中，糖尿病在2013年的医疗保健支出最高，估计为1014亿美元（不确定区间[UI]，967亿美元-1065亿美元），其中57.6%（UI，53.8%-62.1%）用于药物，23.5%（UI，21.7%-25.7%）用于门诊护理。缺血性心脏病占2013年医疗保健支出的第二高金额，估计支出为881亿美元（UI，827亿-929亿美元），腰痛和颈部疼痛占第三高金额，估计医疗保健支出为876亿美元（UI，675亿-941亿美元）。支出水平最高的条件因年龄、性别、护理类型和年份而异。从1996年到2013年，155个条件中有143个条件的个人医疗保健支出增加。在过去18年中，下背部和颈部疼痛以及糖尿病的支出增长最多，估计分别为572亿美元（UI，474亿美元-644亿美元）和644亿美元（UI，578亿美元-707亿美元）。从1996年到2013年，紧急护理和零售药品的支出增长最快（年增长率分别为6.4% [UI，6.4%-6.4%]和5.6% [UI，5.6%-5.6%]），高于住院治疗支出的年增长率（2.8% [UI，2.8%-2.8%]和护理设施护理（2.5% [UI，2.5%-2.5%]）。对美国个人医疗保健和公共卫生支出的模拟估计显示，从1996年到2013年，美国在个人医疗保健和公共卫生方面的支出大幅增加;糖尿病、缺血性心脏病和下背痛和颈部疼痛的支出占疾病类别支出的最高金额。不同条件和护理类型的年度支出变化率差异很大。这一信息可能对控制美国医疗保健支出的努力产生影响。
US health care spending has continued to increase, and now accounts for more than 17% of the US economy. Despite the size and growth of this spending, little is known about how spending on each condition varies by age and across time. To systematically and comprehensively estimate US spending on personal health care and public health, according to condition, age and sex group, and type of care. Government budgets, insurance claims, facility surveys, household surveys, and official US records from 1996 through 2013 were collected and combined. In total, 183 sources of data were used to estimate spending for 155 conditions (including cancer, which was disaggregated into 29 conditions). For each record, spending was extracted, along with the age and sex of the patient, and the type of care. Spending was adjusted to reflect the health condition treated, rather than the primary diagnosis. Encounter with US health care system. National spending estimates stratified by condition, age and sex group, and type of care. From 1996 through 2013, $30.1 trillion of personal health care spending was disaggregated by 155 conditions, age and sex group, and type of care. Among these 155 conditions, diabetes had the highest health care spending in 2013, with an estimated $101.4 billion (uncertainty interval [UI], $96.7 billion–$106.5 billion) in spending, including 57.6% (UI, 53.8%–62.1%) spent on pharmaceuticals and 23.5% (UI, 21.7%–25.7%) spent on ambulatory care. Ischemic heart disease accounted for the second-highest amount of health care spending in 2013, with estimated spending of $88.1 billion (UI, $82.7 billion–$92.9 billion), and low back and neck pain accounted for the third-highest amount, with estimated health care spending of $87.6 billion (UI, $67.5 billion–$94.1 billion). The conditions with the highest spending levels varied by age, sex, type of care, and year. Personal health care spending increased for 143 of the 155 conditions from 1996 through 2013. Spending on low back and neck pain and on diabetes increased the most over the 18 years, by an estimated $57.2 billion (UI, $47.4 billion–$64.4 billion) and $64.4 billion (UI, $57.8 billion–$70.7 billion), respectively. From 1996 through 2013, spending on emergency care and retail pharmaceuticals increased at the fastest rates (6.4% [UI, 6.4%–6.4%] and 5.6% [UI, 5.6%–5.6%] annual growth rate, respectively), which were higher than annual rates for spending on inpatient care (2.8% [UI, 2.8%–2.8%] and nursing facility care (2.5% [UI, 2.5%–2.5%]). Modeled estimates of US spending on personal health care and public health showed substantial increases from 1996 through 2013; with spending on diabetes, ischemic heart disease, and low back and neck pain accounting for the highest amounts of spending by disease category. The rate of change in annual spending varied considerably among different conditions and types of care. This information may have implications for efforts to control US health care spending.
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