PBS高端访谈:医疗支出增加但增度放缓

 　　JUDY WOODRUFF:Now: what's behind the continuing rise in health care spending and why the rate of growth has slowed.

　　Ray Suarez has the story.

　　RAY SUAREZ:For the third consecutive¹ year, health care spending in the U.S. grew by just under 4 percent.

　　Government data released today show that roughly 2.7 trillion dollars was spent in total in 2011, or just under $8,700 a person. That 4 percent increase is above the rate of inflation, but it's well below the recent historical trends.

　　The information was published today in the journal "Health Affairs."

　　And to help us break it down, I'm joined again by Susan Dentzer. She's the editor of the journal and an analyst² for the NewsHour.

　　And, Susan, has this ever happened before? Have we ever had a three-year run of such modest price increases?

　　SUSAN DENTZER,"Health Affairs":Not in the 52 years in which these national health expenditure³ data have been collected.

　　It really is unprecedented⁴. And, clearly, it's very much linked to the very dramatic recession we had and the slow growth period that has followed it. We never have seen though—even though it is the case that recessions always produce a slowdown in health care spending growth, we have never seen one quite of this magnitude. And it didn't—it never has kicked in quite as early as this one did.

　　It's almost if, as soon as the recession set in, health spending growth really plummeted⁵ and we continue to see the effects to this day.

　　RAY SUAREZ:So if the recession is a part of it, do we know whether it was from people trying to spend less on health care, whether this was consumer-driven, or on the provision side, were the price increases just not there because the providers didn't think they can get those prices?

　　SUSAN DENTZER:Clearly, more of it was happening on the so-called demand side. We had about seven million people lose health insurance and health care coverage⁶ on net.

　　And, of course, numbers of people actually qualified⁷ for Medicaid and got coverage, but the net effect was seven million people between 2007 and 2010 without—additional people without health insurance.

　　Also, we had a lot of people now—we do have a lot of people who are in so-called consumer-directed health plans, high-deductible health plans. They're responsible for a good share of their health care spending typically.

　　Those people are probably the kinds of people who put health care spending, if it was discretionary, on hold over the course of the recession, as they were obviously worried about their jobs and their income. So, we saw just across the board people not getting health care, people not having insurance coverage and not getting health care. And that was probably the biggest driver of this effect.

　　RAY SUAREZ:Even with the large number of Americans unemployed⁸, the large number uninsured, most Americans still are covered by workplace-based employer health care plans. Was there anything different about the way money was being spent there?

　　SUSAN DENTZER:Well, again, to the degree those people, some of them are in high-deductible health plans, yes, they seem to be spending less, and sometimes even on things that they're actually covered for.

　　We have seen health spending increases in the employer-covered population also moderate. Overall, health insurance premiums¹⁰ for the whole population, private health insurance premiums are also rising, or at least as of 2011 were still rising at about 4 percent across the board.

　　And for employer groups, typically large employer groups, it's also been in that range, 3-4 percent.

　　Most recently, we are seeing some tick up in people who are not in large employer groups. Those are people who are either in individual health insurance or small business health insurance. Those historically have been the areas of health insurance coverage that have been the most volatile¹¹ and most subject to price increases and price swings. So we still are seeing that.

　　But, again, the bigger picture at least through 2011 was this rate of growth that is much closer to the overall rate of growth of the general economy.

　　RAY SUAREZ:Is this a pretty uniform phenomenon, or are there regional variations? Are there places in America where it's a relative bargain to get health care?

　　SUSAN DENTZER:There are some regional variations. It's also very important to note, though, that there are program-by-program differences.

　　Medicaid spending on a per-person basis, actually, it looks like, fell in 2011, according to these data, whereas Medicaid spending on a per-enrollee basis was up.

　　Also, within the Medicare program, if you were in the Medicare Advantage program, which is the HMOs and PPOs, that side of Medicare, as opposed to the free-for-service program, there were different rates of growth in the program.

　　So it's a big story. A $2.7 trillion health care system is a big story. And we do see this kind of patchwork¹² quilt of different things going on, depending on what piece of the quilt you're looking at.

　　RAY SUAREZ:Today, the secretary of HHS noted¹³ that it's roughly the same amount of GDP year on year on year over these three years, that it hasn't been growing as a share of the economy.

　　But also a report over the weekend came out that showed that some people who are in those small groups buying their own insurance have been faced by tremendous increases, 15, 17, 20 percent in the cost of their insurance policies.

　　SUSAN DENTZER:Yes.

　　And we can imagine—we don't know this for a fact, because—we don't have access to all of the underlying¹⁴ data here, but what it looks like certainly happened—and, in fact, the chief actuary of the Centers for Medicare and Medicaid Service made the point in a news conference we had today—if you think about people who were in small employment groups or individual insurance, particularly over the course of the recession, a lot of people lost that coverage.

　　A lot of small businesses dropped coverage. A lot of people who had individual insurance couldn't afford it anymore. People who stayed insured were most likely were people who really needed coverage. They were likely to be people who had a multiple chronic¹⁵ disease. And probably what happened is those people were very high utilizers of their health coverage.

　　So, what is possibly going on now is insurers are saying, well, we spent a lot of money on this population. We have to re-price that going forward.

　　Now, it's true that the new health care reform law gives states and the federal government tools to push back on health insurance premium⁹ increases that are not warranted. But, clearly, some of them are. And a lot of it is this increase in utilization¹⁶ that we see from a high-use population of chronically¹⁷ ill people.

　　RAY SUAREZ:Susan Dentzer, as always, thanks for joining us.

　　SUSAN DENTZER:Great to be with you, Ray.

1 consecutive   

adj.连续的，联贯的，始终一贯的

参考例句：

• It has rained for four consecutive days.已连续下了四天雨。
• The policy of our Party is consecutive.我党的政策始终如一。

2 analyst   

n.分析家，化验员；心理分析学家

参考例句：

• What can you contribute to the position of a market analyst?你有什么技能可有助于市场分析员的职务？
• The analyst is required to interpolate values between standards.分析人员需要在这些标准中插入一些值。

3 expenditure   

n.(时间、劳力、金钱等)支出；使用，消耗

参考例句：

• The entry of all expenditure is necessary.有必要把一切开支入账。
• The monthly expenditure of our family is four hundred dollars altogether.我们一家的开销每月共计四百元。

4 unprecedented   

adj.无前例的，新奇的

参考例句：

• The air crash caused an unprecedented number of deaths.这次空难的死亡人数是空前的。
• A flood of this sort is really unprecedented.这样大的洪水真是十年九不遇。

5 plummeted   

v.垂直落下，骤然跌落( plummet的过去式和过去分词 )

参考例句：

• Share prices plummeted to an all-time low. 股票价格暴跌到历史最低点。
• A plane plummeted to earth. 一架飞机一头栽向地面。 来自《简明英汉词典》

6 coverage   

n.报导，保险范围，保险额，范围，覆盖

参考例句：

• There's little coverage of foreign news in the newspaper.报纸上几乎没有国外新闻报道。
• This is an insurance policy with extensive coverage.这是一项承保范围广泛的保险。

7 qualified   

adj.合格的，有资格的，胜任的，有限制的

参考例句：

• He is qualified as a complete man of letters.他有资格当真正的文学家。
• We must note that we still lack qualified specialists.我们必须看到我们还缺乏有资质的专家。

8 unemployed   

adj.失业的，没有工作的；未动用的，闲置的

参考例句：

• There are now over four million unemployed workers in this country.这个国家现有四百万失业人员。
• The unemployed hunger for jobs.失业者渴望得到工作。

9 premium   

n.加付款；赠品；adj.高级的；售价高的

参考例句：

• You have to pay a premium for express delivery.寄快递你得付额外费用。
• Fresh water was at a premium after the reservoir was contaminated.在水库被污染之后，清水便因稀而贵了。

10 premiums   

n.费用( premium的名词复数 )；保险费；额外费用；（商品定价、贷款利息等以外的）加价

参考例句：

• He paid premiums on his life insurance last year. 他去年付了人寿保险费。 来自《现代英汉综合大词典》
• Moves are afoot to increase car insurance premiums. 现正在酝酿提高汽车的保险费。 来自《简明英汉词典》

11 volatile   

adj.反复无常的，挥发性的，稍纵即逝的，脾气火爆的；n.挥发性物质

参考例句：

• With the markets being so volatile,investments are at great risk.由于市场那么变化不定，投资冒着很大的风险。
• His character was weak and volatile.他这个人意志薄弱，喜怒无常。

12 patchwork   

n.混杂物；拼缝物

参考例句：

• That proposal is nothing else other than a patchwork.那个建议只是一个大杂烩而已。
• She patched new cloth to the old coat,so It'seemed mere patchwork. 她把新布初到那件旧上衣上，所以那件衣服看上去就象拼凑起来的东西。

13 noted   

adj.著名的，知名的

参考例句：

• The local hotel is noted for its good table.当地的那家酒店以餐食精美而著称。
• Jim is noted for arriving late for work.吉姆上班迟到出了名。

14 underlying   

adj.在下面的，含蓄的，潜在的

参考例句：

• The underlying theme of the novel is very serious.小说隐含的主题是十分严肃的。
• This word has its underlying meaning.这个单词有它潜在的含义。

15 chronic   

adj.(疾病)长期未愈的，慢性的；极坏的

参考例句：

• Famine differs from chronic malnutrition.饥荒不同于慢性营养不良。
• Chronic poisoning may lead to death from inanition.慢性中毒也可能由虚弱导致死亡。

16 utilization   

n.利用，效用

参考例句：

• Computer has found an increasingly wide utilization in all fields.电子计算机已越来越广泛地在各个领域得到应用。
• Modern forms of agricultural utilization,have completely refuted this assumption.现代农业利用形式，完全驳倒了这种想象。

17 chronically   

ad.长期地

参考例句：

• Similarly, any pigment nevus that is chronically irritated should be excised. 同样，凡是经常受慢性刺激的各种色素痣切勿予以切除。
• People chronically exposed to chlorine develop some degree of tolerance. 人长期接触氯气可以产生某种程度的耐受性。