Medical Care Output and Productivity
美国医疗支出占GDP比例全球最高，但健康指标未领先，引发对其生产率的质疑。本文讨论医疗产出难以衡量的问题，包括价格数据缺失、道德风险、医患关系及产出定义困难。
As a proportion of GDP, the USA spends more than any other country on health care. Yet it is not obvious that there is a substantial return to justify this higher level of spending. Against most indicators of health (infant mortality, life expectancy, etc.), the USA does not top the international league. In view of this, the productivity of US health care has been long questioned. Health sector productivity is not measured easily. In most sectors, real output is calculated by dividing sales or revenue data by a price index. In the health sector, though, reliable data on sales, revenue and prices are not readily available. Valuing the contribution to social welfare is complicated because third‐party coverage, moral hazard, the principal‐‐agent relationships that pervade doctor–patient interactions, and administratively determined prices all conspire to ensure that marginal private and social costs diverge. Moreover, output is difficult to define, let alone quantity. How can the treatment impact on quality of life be captured? How much of a change in health status should be attributed to medical intervention and how much to non‐medical factors?