Behind a Global Drop in Health Care Costs /全球医疗支出降低的原因

纽约时报

We tend tothink of health care as a local good. Most people use the doctor or hospital intheir neighborhood. China does not export medical care. Health and life spansdiffer from country to country, even region to region.

我们通常认为医疗照护具有在地性，多数人求助于家附近的医师与医院。中国大陆不输出医疗保健。人们的健康与寿命随国家甚至区域而异。

But when it comes to health care spending, thepicture is starting to look more global.

至于医疗保健的开支，全球化样貌已经浮现。

After decades when health spending in the UnitedStates grew much faster than it did in other Western countries, a new patternhas emerged in the last two decades. And it has become particularly pronouncedsince the economic crisis. The rate of health cost growth has slowed substantiallysince 2000 in every high-income country, including the United States, Canada,Britain, France, Germany and Switzerland, according to data from theOrganization for Economic Cooperation and Development.

数十年来，美国的医疗开支成长幅度比其他西方国家大上许多，过去20年则已出现新的形态，经济危机出现后尤其明显。根据经济合作暨发展组织（OECD）的统计，自2000年起，每一个高收入国家的医疗支出成长都大幅减缓，其中包括美国、加拿大、英国、法国、德国与瑞士。

“Weused to be different,” said Louise Sheiner of the Brookings Institution inWashington, “Since about 1990, we’ve looked about the same.”

华府布鲁金斯研究所的露易丝．谢纳说：「我们曾经各不相同。大约1990年起，我们却看起来大同小异。」

The synchronized slowdown offers reasons to beskeptical about neat explanations for the trends in any one country, be itlocal changes in medical practices or various attempts to slow cost growth. Theslowdown has also reduced budget pressures around the world.

各国支出同步减缓，使我们有理由怀疑任一国家对最新趋势的简单解释，无论是在地的医疗做法改变或是减缓成本增速的各种尝试。增速减缓同时减轻了各国承受的预算压力。

What’s behind the pattern? Economic growth aroundthe industrialized world has been slow for much of the last decade, and theaging of the population in much of the world has created fiscal pressures torein in health spending. But these economic and political forces – which inturn leave governments and households with less money to purchase medical care– do not appear to be the only causes.

背后的因素是什么？过去10年的许多时候，工业化世界的经济成长全面减缓，全球许多地区人口老化的趋势则产生抑制医疗健保开支的压力。这些经济与政治力量虽使各国ZF与家庭较无力购买健保，却似乎不是仅有的因素。

The world’s health-care systems are also convergingin important ways. New drugs and medical advances, which were once adoptedlocally and spread more slowly, are now experiencing international launches.Medical technology companies are increasingly global, and seeing regulatoryapproval in many markets at once. Strategies that can reduce the need forexpensive hospital stays, such as performing surgeries in outpatient clinics, areexpanding around the world.

全球各国医疗体系也已经开始以重要的方式汇流。新药与医学研究进展曾经只能在地采用，推广也比较缓慢，如今已开始具有国际化性质。医疗技术公司越来越全球化，并在许多市场同时获得有关当局核准。可减少昂贵住院需求的策略，如门诊手术，开始在各地推展。

Two recent papers highlighted the trend. One in TheJournal of the American Medical Association compared the United States withcountries in the O.E.C.D. Its author, David Squires of the Commonwealth Fund, aNew York health care research group, concluded that the similarities inspending growth suggested that “the factors that stimulated the slowdown in theUnited States also affected other industrialized countries.”

两项新报告凸显这种趋势。发表在美国医学学会期刊的报告比较美国与OECD国家。执笔人纽约研究机构「联邦基金」的史奎尔斯指出，开支成长趋势相似意味「在美国促成减缓的因素也影响其他工业化国家」。

The other paper, from the O.E.C.D., found that whatreally differentiates the United States from other countries is the high priceswe have long paid for medical care, not differences in how doctors are treatingtheir patients.

另一项由OECD发表的报告指出，美国不同于他国是长期以来美国医疗收费较高，而非医师诊治方式不同所致。

The economic crisis drove down demand for newmedical services, as people lost their jobs and coverage, or simply decided toput off elective procedures like knee replacements. Tougher times also led topolicy tightening by federal and state officials – and employers, who haveincreasingly moved from generous health insurance plans to those that exposetheir workers to more out-of-pocket costs.

经济危机使人们失业并失去医疗保险，或者决定暂缓如膝关节更换手术之类自主选择性医疗，对新式医疗服务的需求因而减少。时机歹歹也使联邦、州ZF官员与雇主收紧政策。给员工的慷慨医疗保险日渐转为自付额更高的保险。

Expanded health insurance in the United Statesincluded new people, but it also cut back on spending, much of it from lowerreimbursements to hospitals and insurers.

扩大后的美国联邦医疗保险把更多人纳入，却同时减少开支，相当部分来自减少对医院与保险公司的给付。

At the same time, the development of new expensivemedical technologies has slowed for a decade or so. In the pharmaceuticalmarket, many big blockbuster drugs lost their patent protection, and fewexpensive, mass-market medications have come to replace them.

同时，昂贵新医疗技术的开发已减缓约10年。在制药市场，许多轰动一时的重要药物已失去专利保护，却只有极少数针对大众市场的昂贵新药取代它们。

Many of these same forces affect other countries.They also had fewer new drugs, devices and procedures to adopt. And theireconomies were slammed by the global recession.

这些因素中有不少同样也影响其他国家。可供它们采用的新式药物、仪器与医疗步骤同样变少。它们的经济同样因全球衰退而受创。

Other countries also have political mechanisms toreduce spending. Most countries have aggressive regulatory systems that allowgovernment officials to tamp down health spending directly when times gettough.

其他国家也备有减少开支的相关政治机制。多数国家的积极性法规体系使ZF官员得以在大局吃紧时，直接裁减医疗健保开支。

Still, the similarities among countries are not thesame thing as destiny. Peter Orszag of Citibank said, “Health care slowed downhere and it slowed down there, and that doesn’t mean it’s all entirelycyclical.”

尽管如此，各国间的相似性不同于天命。花旗银行的奥兹沙格说：「许多国家医疗健保开支同步减少。这并不意味它具有绝对的循环性。」