Factors Associated With Increases in US Health Care Spending, 1996-2013
Factors Associated With Increases in US Health Care Spending, 1996-2013
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DOI：
10.1001/jama.2017.15927
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发表时间：
2017-11-07
影响因子：
120.7
通讯作者：
Murray, Christopher J. L.
中科院分区：
文献类型：
--
作者：
Dieleman, Joseph L.;Squires, Ellen;Murray, Christopher J. L.
从1995年到2015年，美国的医疗保健支出大幅增加，2015年占经济的17.8%。随着时间的推移，了解已知因素和支出增加之间的关系可以为政策努力提供信息，以遏制未来的支出增长.OBJECTIVE为了量化与美国医疗保健支出相关的5个基本因素相关的支出变化：人口规模、人口年龄结构、疾病患病率或发病率、服务利用率、从1996年到2013年的5个因素的数据被提取为155个健康状况，36个年龄和性别组，2015年全球疾病负担研究和健康评估研究所2013年美国疾病支出项目中的6种护理。进行分解分析以估计这些因素的变化与卫生保健支出变化之间的关联，并估计健康状况和护理类型之间的变异性。或服务价格和强度。主要结果和措施1996年至2013年卫生保健支出的变化。结果经物价通胀调整后，1996年至2013年，住院、门诊、零售药品、护理设施、急诊和牙科护理的年度医疗保健支出增加了9335亿美元，从1.2万亿美元增加到2.1万亿美元。美国人口规模的增加与23.1%的（不确定区间[UI]，23.1%-23.1%），或269.5美元（UI，2690 - 2700亿美元），支出增加;人口老龄化与11.6%（UI，11.4%-11.8%）或1357亿美元（UI，1333 - 1377）的支出增长相关。疾病患病率或发病率的变化与支出减少2.4%（UI，0.9%-3.8%）或282亿美元（UI，105 - 444美元）相关，而服务利用率的变化与支出的统计学显著变化无关。服务价格和强度的变化与50.0%（UI，45.0%-55.0%）或5835亿美元（UI，5252 - 6414美元）的支出增长相关。这5个因素的影响因健康状况和护理类型而异。例如，1996年至2013年期间，每年糖尿病支出增加64.4美元，（UI，579 - 706亿美元）; 44.4美元（UI，38.7元至49.6元）结论和相关性从1996年到2013年，美国医疗保健支出的增加主要与医疗保健服务的增加有关。价格和强度，但也与人口增长和老龄化呈正相关，与疾病患病率或发病率呈负相关。了解这些因素及其在健康状况和护理类型之间的变化可能会为控制医疗保健支出的政策努力提供信息。
IMPORTANCE Health care spending in the United States increased substantially from 1995 to 2015 and comprised 17.8% of the economy in 2015. Understanding the relationship between known factors and spending increases over time could inform policy efforts to contain future spending growth.OBJECTIVE To quantify changes in spending associated with 5 fundamental factors related to health care spending in the United States: population size, population age structure, disease prevalence or incidence, service utilization, and service price and intensity.DESIGN AND SETTING Data on the 5 factors from 1996 through 2013 were extracted for 155 health conditions, 36 age and sex groups, and 6 types of care from the Global Burden of Disease 2015 study and the Institute for Health Metrics and Evaluation's US Disease Expenditure 2013 project. Decomposition analysis was performed to estimate the association between changes in these factors and changes in health care spending and to estimate the variability across health conditions and types of care.EXPOSURES Change in population size, population aging, disease prevalence or incidence, service utilization, or service price and intensity.MAIN OUTCOMES AND MEASURES Change in health care spending from 1996 through 2013.RESULTS After adjustments for price inflation, annual health care spending on inpatient, ambulatory, retail pharmaceutical, nursing facility, emergency department, and dental care increased by $933.5 billion between 1996 and 2013, from $1.2 trillion to $2.1 trillion. Increases in US population size were associated with a 23.1% (uncertainty interval [UI], 23.1%-23.1%), or $269.5 (UI, $269.0-$270.0) billion, spending increase; aging of the population was associated with an 11.6%(UI, 11.4%-11.8%), or $135.7 (UI, $133.3-$137.7) billion, spending increase. Changes in disease prevalence or incidence were associated with spending reductions of 2.4%(UI, 0.9%-3.8%), or $28.2 (UI, $10.5-$44.4) billion, whereas changes in service utilization were not associated with a statistically significant change in spending. Changes in service price and intensity were associated with a 50.0% (UI, 45.0%-55.0%), or $583.5 (UI, $525.2-$641.4) billion, spending increase. The influence of these 5 factors varied by health condition and type of care. For example, the increase in annual diabetes spending between 1996 and 2013 was $64.4 (UI, $57.9-$70.6) billion; $44.4 (UI, $38.7-$49.6) billion of this increase was pharmaceutical spending.CONCLUSIONS AND RELEVANCE Increases in US health care spending from 1996 through 2013 were largely related to increases in health care service price and intensity but were also positively associated with population growth and aging and negatively associated with disease prevalence or incidence. Understanding these factors and their variability across health conditions and types of care may inform policy efforts to contain health care spending.