海外医疗体系研究（一）：美国医疗体系“支付”问题研究

Investment Rating - The report rates the pharmaceutical and biotechnology industry as "Outperform" [1] Core Insights - The U.S. plays a crucial role in the global pharmaceutical industry, serving as a significant revenue source for both domestic and European pharmaceutical companies. The U.S. market is particularly friendly to innovative drug pricing, which influences global pricing strategies [8][9] - The U.S. healthcare system's payment structure offers valuable insights for other countries, with diverse payment systems balancing cost control and provider incentives. The changes in the U.S. payment system may create new market opportunities for Chinese pharmaceutical companies [9][10] Summary by Sections 1. Payment Total and Distribution - The U.S. has the highest per capita healthcare spending among OECD countries, with 2019 figures showing $11,072 per person, significantly above the OECD average of $4,224 [11] - Healthcare providers and pharmaceutical companies benefit from high U.S. healthcare spending, with hospital services accounting for 33% of total healthcare expenditure in 2018 [13][14] - In 2021, U.S. per capita spending on outpatient and inpatient services reached $7,500, approximately 2.5 times higher than comparable countries [16] 2. Payment Sources - The U.S. healthcare payment system is diverse, including public insurance, private insurance, and out-of-pocket payments. Public insurance primarily covers the elderly and low-income individuals [24][26] - In 2022, 68.7% of the U.S. population was covered by private insurance, with 54.8% through employer-sponsored plans [26][28] - Public insurance programs like Medicare and Medicaid play a significant role, covering 18.5% and 21.2% of the population, respectively [26][28] 3. Payment Standards - The U.S. has a varied payment standard for healthcare services, with different standards applied by various payers. Medicare and Medicaid utilize cost control measures, while private insurance offers more flexibility [30][31] - The U.S. pharmaceutical pricing system is influenced by Pharmacy Benefit Managers (PBMs), which negotiate prices between drug manufacturers and insurers, contributing to high drug costs [21][22] - The Inflation Reduction Act (IRA) allows the government to negotiate prices for certain drugs under Medicare, marking a shift in the U.S. approach to drug pricing [46]