Background In England, rises in healthcare expenditure consistently outpace growth in both GDP and total public expenditure. To ensure the National Health Service (NHS) remains financially sustainable, relevant data on healthcare expenditure are needed to inform decisions about which services should be delivered, by whom and in which settings. Methods We analyse routine data on NHS expenditure in England over 9 years (2008/09 to 2016/17). To quantify the relative contribution of the different care settings to overall healthcare expenditure, we analyse trends in 14 healthcare settings under three broad categories: Hospital Based Care (HBC), Diagnostics and Therapeutics (D&T) and Community Care (CC). We exclude primary care and community mental health services settings due to a lack of consistent data. We employ a set of indices to aggregate diverse outputs and to disentangle growth in healthcare expenditure that is driven by activity from that due to cost pressures. We identify potential drivers of the observed trends from published studies. Results Over the 9-year study period, combined NHS expenditure on HBC, D&T and CC rose by 50.2%. Expenditure on HBC rose by 54.1%, corresponding to increases in both activity (29.2%) and cost (15.7%). Rises in expenditure in inpatient (38.5%), outpatient (57.2%), and A&E (59.5%) settings were driven predominately by higher activity. Emergency admissions rose for both short-stay (45.6%) and long-stay cases (26.2%). There was a switch away from inpatient elective care (which fell by 5.1%) and towards day case care (34.8% rise), likely reflecting financial incentives for same-day discharges. Growth in expenditure on D&T (155.2%) was driven by rises in the volume of high cost drugs (270.5%) and chemotherapy (110.2%). Community prescribing grew by 45.2%, with costs falling by 24.4%. Evidence on the relationship between new technologies and healthcare expenditure is mixed, but the fall in drug costs could reflect low generic prices, and the use of health technology assessment or commercial arrangements to inform pricing of new medicines. Conclusions Aggregate trends in HCE mask enormous variation across healthcare settings. Understanding variation in activity and cost across settings is an important initial step towards ensuring the long-term sustainability of the NHS.

中文翻译：

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英国NHS中医疗保健支出的趋势和驱动因素：回顾性分析。

背景信息在英格兰，医疗保健支出的增长始终超过GDP和公共总支出的增长。为了确保国家卫生局（NHS）在财务上保持可持续发展，需要有关卫生保健支出的相关数据，以决定应提供哪些服务，由谁提供以及在哪些环境下提供服务。方法我们分析了过去9年（2008/09至2016/17）英格兰的NHS支出的常规数据。为了量化不同护理环境对总体医疗保健支出的相对贡献，我们分析了三大类14种医疗环境的趋势：基于医院的护理（HBC），诊断和治疗学（D＆T）和社区护理（CC）。由于缺乏一致的数据，我们排除了初级保健和社区精神卫生服务的设置。我们采用了一组指数来汇总各种产出，并消除由于成本压力导致的活动推动的医疗保健支出增长。我们从已发表的研究中找出观察到的趋势的潜在驱动因素。结果在为期9年的研究期内，NHS在HBC，D＆T和CC上的总支出增长了50.2％。HBC的支出增长了54.1％，与活动（29.2％）和成本（15.7％）的增加相对应。住院患者（38.5％），门诊患者（57.2％）和急症室（59.5％）的支出增加主要是由于活动量增加。短期住院（45.6％）和长期住院（26.2％）的紧急住院率都有所提高。从住院的选择性护理（下降了5.1％）转向日间护理（上升了34.8％），这可能反映了当天出院的经济诱因。D＆T支出（155.2％）的增长是由高成本药物（270.5％）和化学疗法（110.2％）的数量增加所推动的。社区处方增长了45.2％，成本下降了24.4％。关于新技术与医疗保健支出之间关系的证据喜忧参半，但药品成本的下降可能反映出仿制药价格低廉，以及使用卫生技术评估或商业安排来为新药定价提供信息。结论HCE的总体趋势掩盖了整个医疗机构的巨大差异。了解活动和活动成本的变化是确保NHS长期可持续性的重要第一步。成本下降了24.4％。关于新技术与医疗保健支出之间关系的证据喜忧参半，但药品成本的下降可能反映出仿制药价格低廉，以及使用卫生技术评估或商业安排来为新药定价提供信息。结论HCE的总体趋势掩盖了整个医疗机构的巨大差异。了解活动在不同环境下的活动和费用的变化是确保NHS长期可持续性的重要第一步。成本下降了24.4％。关于新技术与医疗保健支出之间关系的证据喜忧参半，但药品成本的下降可能反映出仿制药价格低廉，以及使用卫生技术评估或商业安排来为新药定价提供信息。结论HCE的总体趋势掩盖了整个医疗机构的巨大差异。了解活动和环境之间的差异是确保NHS长期可持续性的重要第一步。结论HCE的总体趋势掩盖了整个医疗机构的巨大差异。了解活动和环境之间的差异是确保NHS长期可持续性的重要第一步。结论HCE的总体趋势掩盖了整个医疗机构的巨大差异。了解活动和环境之间的差异是确保NHS长期可持续性的重要第一步。