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贝克尔:美国的医疗改革(1 )  

2009-06-12 16:11:38|  分类: 默认分类 |  标签: |举报 |字号 订阅

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  简介: 

        美国的医改也箭在弦上, 众多的经济学家发表了自己的看法。 贝克尔认为:评估费用高昂的美国医疗系统的最好方法,是估算出不同的医疗系统对于不同年龄、收入、肤色的人的医疗效果如何,不同平均的寿命,也可以成为很好的评价医疗系统的指标 。              

                                                      June 7, 2009

                                                       Health Care

                                                    Health Care-Becker

The best way to evaluate America's expensive health care system would be to estimate the effects of different kinds of healthcare on the quality and quantity of health for individuals of various ages, incomes, races, and other categories. To my knowledge, no researchers have come close to doing this. Instead, the American system has sometimes been found wanting simply because life expectancies in the United States are at best no better than those in France, Sweden, Japan, Germany, and other countries that spend considerably less on health care, both absolutely and relative to their GDPs.

评估美国费用高昂的医疗制度的最好方法,是评价出不同的医疗体制,对于不同年龄、收入、肤色的人的医疗效果如何。据我所知,现在还没有人做类似的研究。相反,人们对美国医疗体系的期望只是:美国人的平均寿命至少要和法国,瑞士,日本,德国及其他国家持平。这些国家在医疗保健方面的投入,绝对或相对的低于其GDP应赋予医疗方面的投入。

Life expectancy is surely one supremely important measure of health since individuals in rich countries are willing to pay a lot even for small increases in their probabilities of surviving different ages (see the studies in the book "Measuring the Gains from Medical Research", ed. By Kevin M. Murphy and Robert Topel, 2003). Studies show that an additional year of life is worth over $120,000 to the typical American adult, apparently also including older adults, where "worth" is measured by willingness to pay for a one-year improvement in length of life. One can easily see without a lot of fancy calculations that the large sums Americans are willing to pay for improvements in health imply that they would pay a considerable fraction of their incomes in order to achieve significant improvements in their life expectancy, and also in their quality of life. Similar conclusions apply to other countries since the willingness to pay in different countries for an additional year of life varies approximately proportionately to their per capita incomes.

平均寿命想必是衡量一个国家健康状况的一个非常重要的指标,因为对身处富裕国家的人而言,即使是在各个年龄段能够存活的概率很小,他们也愿意付很多钱来活命。(参考专著《measuring the Gains from Medical research 作者 Kevin M. MurphyRobert 2003 )。研究显示,对一个普通美国成年人来说,多活一年,其价值就超过20000美元,这显然包括老年人——对于他们来说,这个“价格”代表着他们为了能够多活一年而愿意支付的数额。不需要很复杂的计算,我们可以很容易的看出,那将是多大一笔钱——美国人愿意拿出他们收入的大部分,来延长寿命和改善生活质量。同样的结论也适用于其它国家,差别只是,不同国家的人从工资中拿出钱的比例不尽相同而已 。

Although such calculations show that improvements in life expectancy are worth a lot to most people, national differences in life expectancies are a highly imperfect indicator of the effectiveness of health delivery systems.for example, life styles are important contributors to health, and the US fares poorly on many life style indicators, such as incidence of overweight and obese men, women, and teenagers. To get around such problems, some analysts compare not life expectancies but survival rates from different diseases. The US health system tends to look pretty good on these comparisons.

 这样的计算表明,对大多数人而言,改善平均寿命有多重要,对于不同的国家来说,不同平均寿命值,就成了很好的评价医疗制度的指标。例如,生活方式对保持健康很重要,但同时,美国人的生活方式就不是那么好,看看男人、女人和青少年肥胖症的发病率,就知道了。为了解决这个问题,一些分析家们倾向于,分析不同疾病下的存活率而不是平均寿命。而在这些方面,美国的医疗体系表现得相当好。

A study published in Lancet Oncology in 2007 calculates cancer survival rates for both men and women in the United States, the United Kingdom, and the European Union as a whole. The study claims that the most important determinants of cancer survival are early diagnosis, early treatment, and access to the best drugs, and that the United States does very well on all three criteria. Early diagnosis helps survival, but it may also distort the comparisons of five or even ten-year survival rates. In any case, the calculated five-year survival rates are much better in the US: they are about 65% for both men and women, while they are much lower in the other countries, especially for men. These apparent advantages in cancer survival rates are large enough to be worth a lot to persons having access to the American health system.

 一项发表于2007年,关于肿瘤手术的存活率的研究报告显示(把美国、英国和欧盟的男女当做一个整体),战胜癌症的决定因素包括:早诊断、早治疗以及好的药物。美国在这三个方面表现都非常好。早诊断,有助于从癌症中存活,但是它也会影响未来5年乃至10年的存活率数值。无论在何种情况下,美国在连续5年存活率上的统计数字都非常高:大概是65%,男女都是——但是,在别的国家存活率却非常低,尤其是男人。这些明显的优势,足以吸引人们,去加入美国的医疗系统,去接受治疗。

 

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