Expanding the National Health Accounts

描述（由申请人提供）：在过去的半个世纪里，医疗费用的持续增长引发了关于医疗价值的激烈争论。美国在医疗保健上花这么多钱值得吗？相对于成本，我们能做些什么来增加医疗支出的收益呢？由于缺乏关于医疗保健的好处的良好信息，特别是关于医疗支出的各个组成部分与由此带来的健康改善之间的联系的信息，有关这些问题的辩论受到了阻碍。这一建议基于一个基本假设，即通过系统地、共同地衡量医疗保健的收益和成本，然后比较两者，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；形成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：衡量人口健康和医疗支出；并考虑过去医疗技术变化的成本和收益，以及旨在提高医疗系统生产力的一系列干预措施。我们建议通过五个具体的研究组成部分来实现这些目标：(1)跟踪人口健康，包括死亡率和生活质量，并根据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)对老年人三种常见疾病的医疗干预的成本和收益进行详细研究：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）；和抑郁。这一建议及其成果具有双重目的——进一步对卫生系统价值进行学术探究，并引导公共政策。我们将与主要学者和政府机构成员合作，以实现这两个目标。建立一套国民健康账户将使我们作为一个社会了解哪些医疗干预措施最有效地改善了美国人口的健康。

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.