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(翻译)美国医疗浪费急待改革

(2008-10-09 16:03:04)
标签:

医疗

美国

浪费

改革

杂谈

分类: 公益事业

Charlottesville, Va. - Seven hundred billion – sound familiar? Yes, that's the cost of the financial-services industry bailout, but it's also about the amount of money America is wasting every year on unnecessary healthcare expenses.

7000亿——合理吗?这是美国政策救市的成本,同时也是美国医疗费用每年浪费的钱。

If we could take the steps needed to save that $700 billion, we could take "just" $100 billion to cover the uninsured and have $600 billion left over for Wall Street.

如果我们能够采取措施,就能节省出7000亿元,拿出1000亿来对付不确定性,剩下6000亿就可以投入华尔街了。

Here's the math: Our current healthcare spending is approximately $2.1 trillion (that's up from $1.3 trillion noninflation adjusted in 2000). We waste an estimated one-third – or about $700 billion – on unnecessary procedures, unnecessary visits to the doctor, overpriced pharmaceuticals, bloated insurance companies, and the most inefficient paper billing systems imaginable.

作一个数学题:目前我们的医疗支出2万1千亿元(根据2000年1万3千亿基础上扣除通货膨胀指数)。我们有1/3在浪费着—— 不必要的程序,不必要的看医生,过高的药价,上涨的医疗保险,低效率的支付系统。

Saving that wasted money can begin with you and me. Medical experts say that 40 percent of our life expectancy can be attributed to lifestyle. We spend about $100 billion per year on costs related to obesity alone.

节约资金可以从你我作起。医疗专家说我们的寿命40%与我们的生活方式有关。我们每年光花在与肥胖有关的疾病上就达1000亿元。

We must examine our role in healthcare. How often do patients visit the physician unnecessarily when a call to the nurse would have been fine? Or rush to get medication for every little cough? We spend 10 percent of all our medical care dollars in the last year of life – about $210 billion – much of which is fueled by demands from patients and families. To best understand how to deal with illness, patients need to make sure the lines of communication are open with their healthcare provider.

我们必须审视我们在医疗中的作用。多长时间看一趟医生为好呢?或者就因为小小的感冒就紧张兮兮?去年,10%的医疗费用,约合2100亿元就是因为病人和家属的要求而花掉了。如何最好地去解决看病问题,病人需要更好地与大夫进行沟通。

Surprisingly little is known even among doctors about whether one medicine works better than another. And in many situations, doctors don't even know how often a patient needs to be seen. Try this: Next time your physician says, "Come back in a year," ask, "Why aren't you telling me two years – or six months?" Asking questions and taking an informed role will help individuals understand how to get the right amount of care.

奇怪的是,即使是大夫也不知道哪种药更加有效。在许多情况下,大夫也不知道病人多长时间来看一次门诊更好。试试这个:下次当你的大夫说“明年再来吧”的时候,你就问他“你为什么不告诉两年后再来或者半年后再来呢?”这有助于你了解如何得到合适的医疗服务。

Rethinking the way we pay doctors would also help significantly to curb waste. Right now, many doctors have incentive to provide services, because they get paid for every one – whether an office visit or an operation. In different parts of the country, patients get two to three times as much care for the same disease, with the same result. If doctors practiced in the lower-cost way (again, with no difference to the patient), some experts estimate $50 billion in savings – just on Medicare expenses.

重新思考我们支付医疗费用的会很大程度帮助我们杜绝浪费。现在,许多大夫更乐意多提供服务,因为他们会从中获利。不同地区同样的病治疗费用会有两到三倍的差别。如果大夫以节省的方法来看病(治疗效果一致),有些专家说将会节省500亿元。

Insurers are another big culprit in racking up unnecessary expenses. Many have different requirements for massive numbers of nurses who "preapprove" expensive procedures, from imaging tests such as X-rays, to blood tests not related to diagnosis. Doctors should be allowed to practice according to established guidelines and then allow the insurance companies to check for compliance.

保险公司是导致不必要开支的另外一个因素。许多保险公司对于护士同意的昂贵的治疗程序有着不同的要求,包括X光、验血和相关测试。大夫必须要按照规定的指导用药,也要允许保险公司检查设备。

Let's consider our medical record-keeping model. It is perhaps one of the most obvious, yet overlooked places where costs can be curbed. For the most part, the process has not changed in the past 50 years. Why?

再看看我们医疗记录系统。这可能是最容易忽视,但最容易控制成本的地方。我们在50年中这一部分从未改变,为什么?

Electronic health records are one of the best ways to improve quality and cost of care. They give doctors instantaneous and the most up-to-date information on how to treat a patient.

电子健康医疗系统是改善质量和降低成本的最好办法,同时还可以为大夫提供即时、更新的患者资料。

The current method of using billing clerks (often two per physician) can add up. Automatic electronic billing direct to the insurance company would not only be more economical it would certainly be more efficient – just think, no more duplication of tests. We're talking an estimated savings of at least $80 billion per year, according to some studies.

现在的情况是,每个大夫都要配两个记账员。如果使用电子化记账,记录会直接到达保险公司,不但经济,而且有效率。想一想,没有任何复制的费用。有关研究表明,这一项会节省开支800亿元。

What about malpractice costs? Doctors must police doctors, before mistakes rack up, not lawyers after the fact.

玩忽职守的成本呢?错误发生前,大夫监管大夫,而不是事后请律师。

And last, the pharmaceutical and device manufacturers: Many other countries have independent boards that assess the value (yes, both the effectiveness and the cost) of drugs and devices. We are overdue for the same.

最后是药厂和医疗器械制造商。其他国家会设立独立委员会来评估这些产品的价值(有效性和成本),我们却作的不够。

The next president, whoever that is, should start by appointing a group made up of those responsible for wasting our dollars – as well as members of Congress and the administration – to examine ways to save and then implement them. It could take at least five years to generate savings, so we have no time to lose. When we save this money and figure ways to apply it to the uninsured, we will have a long-term superwin: better competitiveness and healthcare for all.

下届总统无论是谁,都应该任命一个由专家组成的小组,对此进行调查和采取措施。这也得至少5年才能产生效果,所以我们不能再等了。如果我们能够节省出资金并将之用于未保险者身上,我们就会获得长久的胜利:更好的竞争力和全民医疗。

• Arthur Garson Jr., MD, MPH, is the executive vice president, provost, and former dean of the School of Medicine at the University of Virginia. He is coauthor of "Health Care Half Truths: Too Many Myths, Not Enough Reality."

 

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