TheHealthofNations-DepartmentofEconomicsWord格式.docx

TheHealthofNations-DepartmentofEconomicsWord格式.docx

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TheHealthofNations:

@#@@#@TheContributionofImprovedHealthtoLivingStandards@#@WilliamD.Nordhaus,YaleUniversity ThepresentresearchwassupportedinpartbytheNationalScienceFoundation.IamgratefulforcommentsfromDavidCutler,AngusDeaton,RobertGordon,andT.N.Srinivasan.@#@January25,2002@#@I.Introduction@#@Nationsgenerallymeasuretheireconomicperformanceusingtheyardstickofnationaloutputandincome.Itisnotwidelyrecognized,however,thatconventionalapproachesdoapoorjobofcapturingimprovementsinthehealthofthepopulationinourgrossdomesticproductorincomespercapita.Howwouldstandardeconomicmeasureschangeiftheyadequatelyreflectedimprovementsinthehealthstatusofthepopulationaswellasothergoodsandservices?

@#@Thisisthequestionaddressedinthepresentstudy.@#@Thefirstsectiondiscussesthetheoryofthemeasurementofnationalincome,examinessomeoftheshortcomingsoftraditionalconcepts,andproposesanewconceptthatcanbeusedtoincorporateimprovementsinhealthstatus.Inthesecondsection,wediscusshowtheproposedmeasurefitsintoexistingtheoriesofconsumptionandvaluation.ThethirdsectionappliestheconceptstotheUnitedStatesoverthetwentiethcentury.@#@Attheend,weconcludethataccountingforimprovementsinthehealthstatusofthepopulationwouldmakeasubstantialdifferencetoourmeasuresofeconomicwelfareoverthetwentiethcenturyintheUnitedStates.@#@II.IncludingHealthStatusinMeasuresNationalIncome@#@CurrentApproachestoMeasuringtheContributionofHealthintheNationalAccounts@#@WhiletheGDPandtherestoftheNationalIncomeandProduct@#@Accounts（NIPA）mayseemtobearcaneconcepts,theyaretrulyamongthegreatinventionsofthetwentiethcentury.Muchasasatelliteinspacecansurveytheweatheracrossanentirecontinent,socantheGDPgiveanoverallpictureofthestateoftheeconomy.SincetheirfirstconstructionbySimonKuznets,whowontheNobelprizeinEconomicsforhiscontributionstonationalincomeaccounting,enormousstrideshavebeentakenindevelopingandimprovingindexesofeconomicwelfare.Startingwithrudimentarymeasuresofnationalincomeandoutput,nationsnowhaveawiderangeofindexesthatnotonlyincludeconventionalconceptsbutalsodisaggregatetheseforindustriesandregions,useimprovedtechniquesforaggregation,anddisplayawealthofdetail.@#@Nevertheless,sincethebeginning,therehavebeenconcernsthattheaccountsareincompleteandmisleadingbecausetheyomitmostnonmarketactivity.Tomeetthiscriticism,privatescholarsaswellasofficialstatisticalagencieshavebegunextendingthenationalaccountstoincludeseveralnonmarketsectors,includingnationalresources,theenvironment,transportation,leisuretime,andunpaidwork. SeeEisner[1989].ArecentreviewofenvironmentalandotheraspectsofnonmarketaccountingiscontainedinNationalResearchCouncil[1999].@#@Onequestionthathasbeenvirtuallyignoredinattemptstoextendthenationalaccountsistheneedtoaccountadequatelyforimprovementsinhumanhealth.Itislittleunderstoodoutsidethepriesthoodofnationalaccountantsthatthereisnoseriousattempttomeasurethezzrealoutput"@#@ofthehealth-careindustry.Thetechniquesusedtomeasurethepriceandquantityofhealthcarearehighlydefective,andtherearenoattemptstoaccountforimprovementsinthelengthoflifeintocurrentmeasuresoflivingstandards.@#@Itmightbearguedthatincludinghealthstatusissomeradical,far-out,andwoolly-headedattempttoincorporateintangible,non-economiczandsociologicalmeasuresintooursocialaccounts.Thisargumentiswrong,forhealth-careexpendituresarealreadyincludedinmeasuresofnationalincomeandoutput.IndeedtheyareagrowingfractionofGDP-thefractionofpersonalconsumptionexpendituresdevotedtomedicalcarerosefrom5.1percentin1959to15.3percentin1998.Whatisradicalisnottheinclusionofhealthcarebutthenotionadvancedherethatweshouldmakeaseriousattempttomeasuretheoutputofthehealthcaresectorandtovaluethisoutputcorrectly.@#@Bothcommonsenseandrecenteconomicstudiessuggestthatthereislittleconnectionbetweenmedicalspendingandthemeasuredeconomicvalueofhealth-statusimprovements.Atacommon-senselevel,thelackofconnectioncomesbecause"@#@real"@#@medical-carespendinginfactmeasuresspendingoninputsratherthantheresultsinhealthoutcomes.Thecurrentapproachistomeasurehealthoutputprimarilybythenumberofphysicianvisits,thenumberofhospital-days,andsimilarmeasuresratherthantheactualdeliveryofservicesorchangesinhealthstatus.Itwillcomeasasurprisetomostnon-economiststhatimprovementsthatcomefromnewproducts,suchasthediscoveryofantibioticsorthesubstitutionofdrugsforinvasivesurgery,arec