OECDのアメリカ経済評価

さて、そのOECDが、「Economic Survey of the United States 2008」を公表しています。

http://www.oecd.org/document/32/0,3343,en_2649_33733_41803296_1_1_1_1,00.html

もちろん、第一のテーマは金融危機への対応ですが、本ブログとしては当然、もう一つのテーマに関心があります。

>Nevertheless, the fruits of growth have not been evenly distributed in recent decades, raising questions about the social sustainability of such growth. There are also growing concerns about highly unequal financial access to health care in the United States, which may contribute to the mediocre health status of the population by international comparison despite very high levels of expenditure. Health insurance reform to give better financial access to health care to low-income persons would help to overcome some equity and efficiency concerns.

しかしながら、成長の果実の分配はここ数十年不公平になっており、そのような成長の社会的持続可能性に疑問を投げかけている。アメリカにおける保健医療への経済的アクセスの過度の不平等さも、医療費がやたらに高いくせに、他の国よりも健康状態が悪いことに貢献している。低所得者が保健医療に経済的にアクセスできるようにする医療保険改革は、こういった平等と効率の問題を解決するだろう。

特に第３章は、この問題を集中的に扱っています。

>In spite of improvements, on various measures of health outcomes the United States appears to rank relatively poorly among OECD countries. Health expenditures, in contrast, are significantly higher than in any other OECD country. While there are factors beyond the health care system itself that contribute to this gap in performance, there is also likely to be scope to improve the health of Americans while reducing, or at least not increasing spending. This chapter focuses on two factors that contribute to this discrepancy between health outcomes and health expenditures in the United States: inequitable access to medical services and subsidised private insurance policies; and inefficiencies in public health insurance. It then suggests two sets of reforms likely to improve the US health-care system. The first is a package of reforms to achieve close to universal health insurance coverage. The second set of reforms relates to payment methods and coverage decisions within the Medicare programme to realign incentives and increase the extent of economic evaluation of different medical procedures.

一番カネがかかるくせに、一番成果が上がっていない。市場経済のイデオローグであるOECDからここまでいわれるのが、アメリカの医療システムであるわけなんですが、日本をそういう劣等生にしたくてしたくてしょうがない人々がいっぱいいるというのが、日本七不思議の一つでしょうか。