Why Behavioral And Environmental Interventions Are Needed To Improve Health At Lower Cost
Why Behavioral And Environmental Interventions Are Needed To Improve Health At Lower Cost
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DOI：
10.1377/hlthaff.2010.1116
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发表时间：
2011-05-01
期刊：
影响因子：
9.7
通讯作者：
Pechacek, Terry
中科院分区：
文献类型：
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作者：
Milstein, Bobby;Homer, Jack;Pechacek, Terry
我们使用了美国卫生系统的动态模拟模型来测试三个建议的战略，以减少死亡和提高干预措施的成本效益：扩大医疗保险覆盖范围，提供更好的预防和慢性病护理，并通过实现更健康的行为和改善环境条件来保护健康。我们发现，每一种方法都可以拯救生命并提供良好的经济价值，但它们结合起来可能更有效。虽然保险和护理可以迅速挽救生命，但它们往往会增加成本。保护的影响逐渐扩大，但随着时间的推移，它是减少死亡人数和降低成本的一个关键因素。只有保护才能减缓疾病和伤害流行率的增长，从而增加而不是加剧对有限初级保健能力的需求。当加入到一个有覆盖和护理的模拟场景中时，保护可以在第10年多挽救90%的生命，减少30%的成本;到第25年，同样的保护投资可以多挽救140%的生命，减少62%的成本。
We used a dynamic simulation model of the US health system to test three proposed strategies to reduce deaths and improve the cost-effectiveness of interventions: expanding health insurance coverage, delivering better preventive and chronic care, and protecting health by enabling healthier behavior and improving environmental conditions. We found that each alone could save lives and provide good economic value, but they are likely to be more effective in combination. Although coverage and care save lives quickly, they tend to increase costs. The impact of protection grows more gradually, but it is a critical ingredient over time for lowering both the number of deaths and reducing costs. Only protection slows the growth in the prevalence of disease and injury and thereby alleviates rather than exacerbates demand on limited primary care capacity. When added to a simulated scenario with coverage and care, protection could save 90 percent more lives and reduce costs by 30 percent in year 10; by year 25, that same investment in protection could save about 140 percent more lives and reduce costs by 62 percent.