Efforts to limit healthcare spending should focus on lowering prices as well as reducing use, argue Dhruv Khullar and Rahul Rajkumar
Healthcare spending is the product of usage and prices, but recent efforts to limit cost growth have focused almost exclusively on the former
Prices paid for healthcare goods and services are much higher in the US than in other developed countries
Substantial variation also occurs in price without clear relation to quality or outcomes
Various mechanisms to reduce prices are discussed
Americans pay higher prices for healthcare than people living in other developed countries. That is true of prices for doctors, especially proceduralists and specialists, and for non-physician goods and services such as drugs, imaging, and technologies. In the US, the price of inpatient medications is generally twice what it is in Canada; a magnetic resonance imaging (MRI) scan costs three times as much as in Australia; and the price of bypass surgery is four times higher than in the Netherlands.1 A recent international comparison found that, while Americans visit doctors and hospitals at similar rates to citizens of other high income countries, they pay a higher unit price for each intervention.2 This simple truth—often overlooked in health policy discussions—drives higher overall healthcare spending in the United States.34
As well as country differences, drug prices vary within the United States: some Americans pay much more than others for the same service. Spending for people with private insurance varies by a factor of three across US healthcare markets and is driven principally by disparities in prices.5 Prices for MRIs are 12 times higher in the most expensive markets than in the least expensive ones and can vary by a factor of nine even within the same area. The price of knee replacement surgery ranges from …

中文翻译：

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降低美国医疗保健价格的创新

Dhruv Khullar和Rahul Rajkumar
Healthcare认为，限制医疗保健支出的努力应集中在降低价格和减少使用上，这是使用率和价格的乘积，但最近为限制成本增长所做的努力几乎完全集中在原先
为医疗保健支付的价格上商品和服务在美国比其他发达国家高出很多
实质性的变化也发生在价格没有明显的关系，以质量或结果
的各种机制，以降低价格进行了讨论
美国人比其他发达国家的人为医疗保健付出的代价更高。对于医生（尤其是程序师和专家）以及非医师产品和服务（例如药物，影像和技术）的价格，确实如此。在美国，住院药物的价格通常是加拿大的两倍。磁共振成像（MRI）扫描的费用是澳大利亚的三倍；搭桥手术的价格是荷兰的四倍。1最近的一项国际比较发现，尽管美国人以与其他高收入国家的公民相似的价格去看医生和医院，但是他们为每次干预支付更高的单价。2个这个简单的事实（通常在健康政策讨论中经常被忽略）促使美国整体医疗保健支出增加。3 4
除了国家/地区的差异外，美国境内的药品价格也有所不同：某些美国人为同一服务支付的费用要比其他人高得多。在美国医疗保健市场中，拥有私人保险的人的支出相差三倍，主要是由价格差异所驱动。5 MRI的价格在最昂贵的市场中比最便宜的市场高12倍，即使在同一地区，价格也可能相差9倍。膝关节置换术的价格范围从…