Inflation spurs health spending in 2000.
Inflation spurs health spending in 2000.
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2000 年，通货膨胀刺激了医疗支出。
DOI：
10.1377/hlthaff.21.1.172
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发表时间：
2002
期刊：
影响因子：
9.7
通讯作者：
Anne B. Martin
中科院分区：
文献类型：
--
作者：
K. Levit;Cynthia Smith;C. Cowan;H. Lazenby;Anne B. Martin
2000年的医疗支出总额为1.3万亿美元，平均每人4,637美元（图表1）。2000年，名义卫生保健支出增长了6.9%，这是第三年加速增长（图表2）。2000年支出增长率上升1.2个百分点，主要反映了整个经济的通货膨胀率上升，而真实的支出只上升了0.3个百分点。1999年和2000年的支出增长略高于国内生产总值的增长，这是第一个迹象，表明保健支出在国内生产总值中所占份额的九年稳定可能即将结束。卫生支出占国内生产总值的比例略有增加，从1999年的13.1%增加到2000年的13.2%。2001年的可用数据表明，随着医疗保健就业（图表3）、医疗通货膨胀和保费增长的升级，GDP增长减速。这表明，在不久的将来，卫生支出占国内生产总值的比例将有更大的增长。1997年至2000年的强劲经济增长和随之而来的劳动力市场紧张，导致那些通过雇主赞助的计划投保的人选择限制较少、成本较高的选择。这导致私人医疗保健支出比1993年至1997年期间增长更快，当时成本控制战略和管理式医疗计划的增加有助于抑制支出增长。不断扩大的预算盈余支持了联邦增加医疗保险资金的政策举措。2000年，国会通过了两项增加医疗保险资金的主要立法：平衡预算细化法案（BBRA）和医疗保险，医疗补助和SCHIP福利改善和保护法案（BIPA）。在《平衡预算法案》（BBA）将医疗保险支出增长率在1998年降至0.6%，1999年降至1.5%之后，《平衡预算法案》的影响使医疗保险支出在2000年增至5.6%。BIPA的全面影响要到2002年才能感受到。由于2000年私营部门和公共部门的服务支出增长率相似（分别为6.9%和7.0%），公共部门在卫生支出中的份额几乎没有变化（图4）。2000年，公共支出占全国卫生总支出的45%，其余为私人支出。
H ealth spending totaled $1.3 trillion in 2000, with spending averaging $4,637 per person (Exhibit 1). Nominal health care expenditures increased 6.9 percent in 2000, the third year of accelerating growth (Exhibit 2). The 1.2-percentage-point gain in the rate of spending growth in 2000 primarily reflects an increase in economywide inflation and a gain of only 0.3 percentage points in real spending. Spending growth in 1999 and 2000 slightly outpaced growth in gross domestic product (GDP), the first sign that the nine-year stability in health spending’s share of GDP may be coming to an end. The health spending share of GDP increased slightly, from 13.1 percent in 1999 to 13.2 percent in 2000. Available data for 2001 indicate that GDP growth decelerated as health care employment (Exhibit 3), medical inflation, and premium growth escalated. This suggests a stronger increase in the health spending share of GDP in the near future. Strong economic growth between 1997 and 2000 and the accompanying tight labor market caused those who are insured through employer-sponsored plans to choose less restrictive, more costly options. This resulted in faster growth in private health care spending than existed between 1993 and 1997, when cost containment strategies and increasing enrollment in managed care plans helped to dampen spending growth. Expanding budget surpluses supported federal policy initiatives that increased funding for Medicare. Congress passed two major pieces of legislation that added to Medicare funding in 2000: the Balanced Budget Refinement Act (BBRA) and the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA). After the Balanced Budget Act (BBA) slowed Medicare spending growth to 0.6 percent in 1998 and 1.5 percent in 1999, the effects of the BBRA boosted Medicare spending to 5.6 percent in 2000. The full effects of BIPA will not be felt until 2002. Because spending for services in both the private and public sectors increased at similar rates in 2000 (6.9 and 7.0 percent, respectively), there was little change in the public share of health spending (Exhibit 4). Public spending in 2000 accounted for 45 percent of all national health expenditures, and private spending, the remainder.