Health Care Reform in the United States

David Careyi ; Bradley Herringii ; Patrick Lenaini iOECDiiJohns Hopkins University

Organisation for Economic Co-operation and Development

关键词: health expenditure;    tax exclusion;    adverse selection;    Medicare;    mandate;    Medicare advantage;    comparative effectiveness;    health oucomes;    health status;    pooling;    individual market;    health subsidies;    health costs;    life expectancy;    moral hazard;   

DOI  :  https://doi.org/10.1787/227104360465

学科分类：社会科学、人文和艺术（综合）

来源: OECD iLibrary

【 摘 要 】

In spite of improvements, on various measures of health outcomes the United States appears to rank relatively poorly among OECD countries. Health expenditures, in contrast, are significantly higher than in any other OECD country. While there are factors beyond the health-care system itself that contribute to this gap in performance, there is also likely to be scope to improve the health of Americans while reducing, or at least not increasing spending. This paper focuses on two factors that contribute to this discrepancy between health outcomes and health expenditures in the United States: inequitable access to medical services and subsidized private insurance policies; and inefficiencies in public health insurance. It then suggests two sets of reforms likely to improve the US health-care system. The first is a package of reforms to achieve close to universal health insurance coverage. The second set of reforms relates to payment methods and coverage decisions within the Medicare programme to realign incentives and increase the extent of economic evaluation of different medical procedures.