Expanding the National Health Accounts

描述(申请人提供)：在过去的半个世纪里，医疗保健费用的持续增长引发了关于医疗保健价值的激烈辩论。美国在医疗保健上花这么多钱值得吗？我们可以做些什么来增加医疗支出相对于成本的好处？由于缺乏关于医疗保健好处的良好信息，特别是医疗支出的个别组成部分与由此产生的健康改善之间的联系，关于这些问题的辩论一直受到阻碍。这一建议基于这样一个基本假设，即通过系统地和联合地衡量医疗服务的效益和成本，然后对两者进行比较，可以最有效地提高医疗保健的生产率。我们称之为国民健康账户；建立这样的账户是这个项目的首要目标。在最广泛的层面上，我们有两个具体目标：在医疗支出的同时衡量人口健康；以及考虑过去医疗技术变化和旨在提高医疗系统生产率的一系列干预措施的成本和收益。我们建议通过五个具体的研究部分实现这些目标：(1)跟踪人口健康，包括死亡率和生活质量，并按症状和损伤以及潜在疾病分解健康趋势；(2)跟踪医疗支出，了解疾病层面的支出增长以及特定服务的成本；(3)、(4)和(5)详细研究医疗干预措施在护理三种常见老年人疾病方面的成本和好处：心血管疾病(包括心脏病和中风)；癌症(肺癌、结直肠癌和乳腺癌)；以及抑郁症。这项提议及其结果具有双重目的--进一步探讨与卫生系统价值有关的学术问题，并确定公共政策的方向。我们将与顶尖学者和政府机构成员合作，以实现这两个目标。建立一套国家健康账户将使我们作为一个社会能够了解哪些医疗干预措施最有效地改善美国人口的健康。

DESCRIPTION (provided by applicant): The relentless increase in medical care costs in the past half century has fueled intense debate over the value of medical care. Is it worth it for the United States to spend so much on medical care? What could we do to increase the benefits of medical spending relative to the costs? Debate about these issues has been hampered by the lack of good information on the benefits of medical care, and particularly, the link between individual components of medical spending and resulting health improvements. This proposal rests on the fundamental assumption that productivity improvement in medical care can be most effectively achieved by measuring systematically and jointly both the benefits and the costs of medical care, and then comparing the two. We term this National Health Accounts; forming such accounts is the overarching goal of this project. At the broadest level, we have two specific aims: to measure population health alongside medical spending; and to consider the costs and benefits of past changes in medical technology and a range of interventions designed to improve the productivity of the medical system. We propose to realize these goals with five specific research components: (1) tracking population health, including both mortality and quality of life, and decomposing health trends by symptoms and impairments, and underlying diseases; (2) tracking medical spending, with an understanding of spending growth at the disease level, and the cost of particular services; (3), (4), and (5) undertaking detailed study of the costs and benefits of medical interventions in the care of three common conditions in the elderly: cardiovascular disease (including both heart disease and stroke); cancer (lung, colorectal, and breast); and depression. This proposal and its resulting products have dual ends - to further academic inquiry relating to health system value and to orient public policy. We will work with leading academics and members of government agencies to reach both goals. Establishment of a set of national health accounts will allow us as a society to understand which medical interventions improve the health of the U.S. population most efficiently.