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Too Much Medical Care?

A few years ago, my daughter sprained her ankle at dance camp. What happened next offers a glimpse into some of the problems in our nation's health care system.


For years, we've been hearing that the United States spends more on health care than any other country, even as it lags far behind other countries in terms of quality of care.


The numbers are staggering. Health spending in the United States neared $2.6 trillion in 2010 - that's 10 times the $256 billion spent in 1980. The Institute of Medicine estimates that in 2009, the most recent year for which data are available, the country spent about $210 billion on unnecessary medical services.

相关数字让人惊愕不已。在2010年,美国在医疗上投入了将近2.6万亿美元,是1980年2560亿美元的10倍。美国医学研究所(The Institute of Medicine)预计,在2009年(这是有数据可查的最近的年份),美国在不必要的医疗服务上就花费了2100亿美元左右。

Broken down, this means that the United States spends about $8,000 per person annually on health care - that's about 50 percent more than Norway and Switzerland. In the United States, hospital stays are far more expensive than those in other countries, averaging about $18,000 per discharge, compared with less than $10,000 in Sweden, Australia, New Zealand, France and Germany.


But what do these numbers really mean to the average patient? What's going on in the doctor's offices and hospitals around the country to create such bloated spending?


That's where my daughter's ankle comes in. At the time, the injury seemed unremarkable. Her pediatrician suggested waiting it out, but after a month with no improvement, I sought a second opinion from a sports medicine specialist, who ordered an M.R.I., but ended up referring her to a pediatric orthopedic surgeon.


The specialist examined the ankle and ordered another M.R.I. as well as extensive blood work. After seven vials of blood, my daughter nearly passed out.


A week later the doctor called. Some of the blood work looked uncertain, and he wanted to retest. After several more vials of blood, the results remained ambiguous. Even so, my daughter was referred to an eye specialist and a pediatric rheumatologist, who ordered more blood work and a third M.R.I. At the end of the appointment, the doctor noticed my daughter's crooked pinkie fingers and, oddly, ordered an X-ray of her hands. Five months after twisting an ankle, my otherwise healthy daughter limped out of the radiology office carrying X-rays of her hands. "Mom,'' she said, "my ankle still hurts."


After years of reporting on health, I considered myself a well-informed patient, but it took my elementary-school daughter to state the obvious: She was the victim of too much medicine. Every new blood test, scan or X-ray raised new questions, which led to more lab work, scans and X-rays. I know the doctors had good intentions, but it's a truism of modern medicine that the more you test and scan and look for problems, the more likely you are to find something wrong. My daughter's case had spiraled out of control.


I canceled all her appointments with the various specialists, and went back to the sports doctor. We discussed a new approach that focused solely on pain relief. He consulted with my daughter's pediatrician, and they agreed on a treatment. Within days, my daughter's ankle had stopped throbbing, and soon she was back to sports and dancing. The cost of this ankle injury had reached well into the thousands of dollars - I had lost track because it was all covered by my insurance.


Solving the problem of excessive health care spending, while finding ways to offer better care to those without insurance, is arguably one of the most pressing issues facing our country. Over the coming weeks, I want to explore the reasons behind our troubled health care system from the perspective of the patient. Along the way, I'll check in with various experts, from physicians on the front lines to policy experts searching for solutions, who can add their own insights to the discussion.


The goal will be to shed light on both the good and the bad in the American health care system and help set the health care agenda for the next president. The series will be part of a larger New York Times project called The Agenda, which will focus on some of the most critical issues that the president and the next Congress will face in the coming months and years.

我们的目标是要厘清美国医疗保健体系中存在的优点和弊端,帮助下一任总统建立一个医疗保健议程。这个系列报道是《纽约时报》一个大型报道项目“议程”(The Agenda)中的部分内容,报道旨在关注总统和下一届国会在未来几个月到几年将要面对的一些最为重大的话题。

Excess Healthcare Spending


Unnecessary Services = $210 billion


Inefficiently Delivered Services = 130 billion


Excess Administrative Costs = 190 billion


Prices that are Too High = 105 billion


Missed Prevention Opportunities = 55 billion


Fraud = $75 billion

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