#记录我的2023##自律学习计划##财经新势力##时事热点头条说#
FOR A LONG time, health care was eating the world. From 1950 to 2009 American spending on hospitals, medics and the like rose from 5% of GDP to 17%. Between the late 1970s and the mid-2010S British public spending on health rose by 4% a year in real terms, much faster than the economy's growth of 2% a year. From 1980 to 2010 overall French prices rose by 150%; the price of caring for a sick or old person rose by 250%. Among economists, the proposition "health care's share of GDP rises" was almost as close to an iron law as "free trade is good" or "rent controls do not work".
很长一段时间，医疗保健一直在占据主导地位。从1950年到2009年，美国在医院、医生等方面的支出从国内生产总值（GDP）的5%增加到17%。从20世纪70年代末到2010年代中期，英国对公共卫生支出以实际增长4%的速度增加，远远快于经济增长的2%。从1980年到2010年，法国的总物价上涨了150%，而照顾生病或年迈人的价格上涨了250%。在经济学家中，"医疗保健占GDP比例上升"这一命题几乎与"自由贸易有益"或"租金管制无效"一样成为一种铁律。
The iron has now melted. Even as populations age, and as the world continues to deal with the fallout from the covid-19 pandemic, health care is no longer taking over the economy. Across the rich world health care's share of GDP jumped in 2020 and 2021, because of a combination of pandemic-related spending and lower GDP. How ever, it has since fallen back to close to its level in 2008 (see chart below). Because of this "flattening of the curve", health spending today is somewhere in the region of $2trn below its pre-2009 trend.
现在，这种铁律已经不再适用。尽管人口老龄化，世界仍在处理covid-19大流行的后果，但医疗保健不再占据经济的主导地位。在富裕国家，由于大流行相关的支出和GDP下降的组合作用，医疗保健在2020年和2021年占GDP的比例上升，但目前已经回落到接近2008年的水平（见下图）。由于这一"曲线趋平"，目前的医疗支出大约比2009年前的趋势低了大约2万亿美元。
In some countries the changes are still more dramatic. The ratio of health-care spending to GDP has fallen from its pre-covid peak in Australia and Sweden. In Norway it has tumbled by a remarkable 2.5 percentage points of GDP from its level in 2016. Even in America-the land of costly health care-something has changed. A new measure published by the Bureau of Economic Analysis suggests that the share of spending going on health care has been falling since before the pandemic. A widespread slowdown has never happened before. It has not even come close to happening.
在一些国家，这些变化变得更加戏剧性。医疗保健支出与GDP的比例在澳大利亚和瑞典已经从covid疫情前的峰值下降。在挪威，自2016年以来，医疗保健支出与GDP之间的比例已经下降了惊人的2.5个百分点。即使在美国这个昂贵医疗保健之地，也发生了一些改变。美国经济分析局发布的一项新指标表明，自疫情爆发前，用于医疗保健支出的份额一直在下降。此类广泛的减速以前从未发生过，甚至没有接近发生过。
Inflation in the global health-care industry, which once looked Argentine, now looks rather more normal. Consider a broad measure of American health-care prices, which includes not only things purchased directly by consumers but also those paid for on their behalf, such as by insurers. From the 1970s to the 2000s annual inflation almost always exceeded the average (see chart below). But in around 2010 that relationship flipped-and much the same is true elsewhere. Relative to the "GDP deflator", an economy wide measure of inflation, the deflator in health and social care across the rich world has pretty much stopped rising. In the 1990s Japanese health inflation soared relative to average prices, but has fallen since 2015. In the French health-and-social-care sector, once dreadful at cost control, prices now grow in line with the economy wide average.
全球医疗保健行业的通货膨胀，曾一度看起来像是阿根廷那样高，现在看起来更加正常。以美国医疗保健价格为代表的广泛衡量指标，不仅包括消费者直接购买的物品，还包括由保险公司代付的物品。从20世纪70年代到2000年代，年通货膨胀几乎总是超过了平均水平（见下图）。但在大约2010年左右，这种关系发生了颠倒，其他地方也是如此。与"GDP累积物价指数"相比，这是富裕国家范围内对通货膨胀的整体度量，医疗和社会保健部门的累积物价指数几乎停止上升。在20世纪90年代，与一般物价相比，日本的医疗保健通货膨胀飙升，但自2015年以来已经下降。在法国的医疗和社会保健领域，曾经糟糕的成本控制现在与整体经济的平均水平同步增长。
To understand the significance of this development, consider some earlier warnings. "Put simply," said President Barack Obama in 2009, "our health-care problem 65 is our deficit problem." In 2017 Britain's fiscal watchdog cautioned that "excess cost growth" in health could add an additional 90% of GDP to Britain's debt by the 2060s. Such statements now look a little outlandish, but few people saw this curve-flattening coming. What prompted it?
为了理解这一发展的重要性，可以考虑一些早期的警告。2009年，美国总统巴拉克·奥巴马曾说："简而言之，我们的医疗保健问题就是我们的赤字问题。"2017年，英国的财政监察机构警告称，医疗保健中的"超额成本增长"可能会在2060年代为英国的债务增加相当于国内生产总值的90%。现在这些说法看起来有些离奇，但很少有人预见到这种"曲线趋平"的发展。是什么促使了这一趋势呢？
Begin with supply-side factors. Falling health-care inflation is consistent with rising health-care productivity. Economists typically think productivity gains in health care are difficult to come by because the service is labour-intensive. It is, for example, unrealistic to expect a phlebotomist to draw a blood sample 3% faster, year after year. Typically this results in "cost disease", where spending must rise over time in order for the service merely to stand still. After all, even if phlebotomists do not get more efficient, they still expect a pay rise every now and then-without them they may be enticed to other sectors. William Baumol, who identified this phenomenon, worried about health-care spending swallowing up an ever-larger share of GDP.
首先，考虑供给方面的因素。医疗保健通货膨胀下降与医疗保健生产率上升是一致的。经济学家通常认为，由于医疗服务劳动密集，医疗保健领域的生产率提高难以实现。例如，不可能指望抽血师每年都能快3%。通常情况下，这会导致"成本疾病"，因为为了让服务维持不变，支出必须随时间增加。毕竟，即使抽血师没有变得更高效，他们仍然偶尔期望加薪，否则他们可能会受到其他行业的诱惑。威廉·鲍默尔（William Baumol）发现了这一现象，担心医疗保健支出将吞噬越来越大比例的GDP。
At the same time, it never seemed plausible that health care was entirely immune to productivity gains. Even for an occasional patient it is blindingly obvious that health systems are ravaged by inefficiencies: paper-based forms instead of digital ones; hours spent filing insurance claims; different parts of the system not talking to one another. Meanwhile, some systems do seem to have improved. According to America's Bureau of Labour Statistics, labour productivity in health care and social assistance fell by 13% between 1990 and 2000, but then made up all the lost ground from 2000 to 2019. In Britain, a study found that staff in the National Health Service (NHS) provided 17% more care pound for pound in 2016 than they did in 2004, compared with productivity growth of 7% in the economy as a whole. All this may have helped keep cost growth under control.
与此同时，医疗保健完全不可能免疫于生产率提高，这似乎也是不切实际的。即使对于偶尔就诊的患者来说，医疗系统存在明显的低效问题：纸质表格而不是数字表格；花在申请医疗保险索赔上的时间；系统的不同部分之间不能互相通信。与此同时，一些系统似乎已经改进了。根据美国劳工统计局的数据，医疗保健和社会援助领域的劳动生产率在1990年到2000年之间下降了13%，但在2000年到2019年间又弥补了失地。在英国，一项研究发现，国民医疗服务（NHS）的工作人员在2016年比2004年提供的护理每英镑成本多17%，而整体经济的生产率增长为7%。所有这些可能有助于控制成本增长。
Another supply-side factor-technological change-may also play a role. Over the long sweep of history, innovations have tended to raise health-care spending. This is in part because they often make therapies available for conditions that were previously impossible to treat. In the 1960s, for instance, the advent of dialysis machines was quite literally a life-saver for people suffering from kidney failure. And yet in the rich world the current cost of a year of dialysis for a patient is somewhere between $40,000 and $60,000, close to these countries' per-person GDP.
另一个供给方面的因素是技术变革，也可能起到一定作用。在历史的长期发展中，创新往往会提高医疗保健支出。部分原因是因为它们通常使治疗对于以前无法治疗的疾病变得可能。例如，在20世纪60年代，透析机的出现对于患有肾衰竭的人来说确实是一个救命的措施。然而，在富裕国家，患者一年的透析费用在40,000美元至60,000美元之间，接近这些国家的人均GDP。
The nature of technological innovation in health care may now be changing. One possibility is that there has been a generalised slowdown in treatments that represent medical breakthroughs and are costly, such as dialysis. But this is difficult to square with a fairly healthy pipeline of drugs coming to market. Another possibility, which is perhaps more plausible, is that the type of advancements has changed, involving a shift from whizzy curative treatments to less glamorous preventive ones. There is decent evidence that the increased use of aspirin, a very low cost preventative treatment, in the 1990s has cut American spending on the treatment of cardiovascular diseases today.
医疗保健领域的技术创新性质现在可能正在发生变化。一种可能性是，代表医疗突破的昂贵治疗的增长减缓，如透析。但这很难与市场上即将上市的药物种类繁多相吻合。另一个可能性，也许更为可信，是创新类型发生了变化，涉及从高科技治疗转向不那么引人注目的预防性治疗。有充分的证据表明，1990年代增加使用阿司匹林（一种非常低成本的预防性治疗）已经降低了美国心血管疾病治疗的支出。