Econ Papers Daily / 工作论文
医疗保健中的地区差异与生产率之谜
Regional Variations and Productivity Puzzles in Health Care
摘要
Health care utilization per capita varies widely across the United States, yet higher utilization areas have no better patient health. In the late 2000s, this pattern was widely interpreted as evidence that health care costs could be cut substantially without harming patients, which in turn shaped the 2010 Affordable Care Act. We describe how our understanding has since evolved, emphasizing three points. First, new evidence indicates quantitatively meaningful roles for both supply-side and demand-side factors in driving regional variation in health care and in health outcomes. Second, health care productivity varies substantially across providers; improving it requires better understanding of why productivity differs. Third, we know even less about the sources of area-level productivity differences. We suggest several ways in which greater engagement with the productivity literature outside of health care could yield valuable insights.
中文摘要
美国各地的人均医疗保健利用差异很大，但利用率较高的地区患者健康状况并没有更好。在2000年代后期，这一模式被广泛解读为医疗保健成本可以大幅削减而不损害患者的证据，进而影响了2010年《平价医疗法案》。我们描述了我们理解此后如何演变，强调三点。第一，新证据表明供给侧和需求侧因素在驱动医疗保健和健康结果的地区差异方面都具有数量上显著的作用。第二，医疗保健生产率在不同提供者之间差异很大；提高生产率需要更好地理解生产率为何不同。第三，我们对地区层面生产率差异的来源了解更少。我们提出若干方式，通过与医疗保健之外的生产率文献更深入接触，可以产生有价值的洞见。