生物医药：百年美国医改史：费用结构、经验和教训

Investment Rating - The industry investment rating is maintained as "Outperform" [1] Core Insights - Contrary to mainstream perception, the U.S. healthcare system is primarily based on public insurance rather than commercial insurance, with public insurance accounting for 52.7% of expenditures in 2022 compared to 28.9% for commercial insurance [2][31] - The U.S. public insurance system is gradually moving towards cost control, but the effectiveness of these measures is currently limited, with public insurance expenditures constituting 26.6% of federal spending in 2023 [2][43] - The ongoing reforms in the U.S. healthcare system provide important insights for other countries, particularly regarding the need for healthcare reform driven by increasing medical demands due to aging populations [2][27] Summary by Sections Section 1: Pathways - The U.S. healthcare reform has historically focused on expanding coverage and controlling costs, with significant political influences shaping the direction of reforms [26] Section 2: Current Status - In 2022, total healthcare spending in the U.S. reached $4.46 trillion, with public insurance being the largest source of funding, accounting for 39.2% of total expenditures [31][33] - The share of public insurance has been increasing, while commercial insurance has seen a declining trend, from 43.0% in 1980 to 28.9% in 2022 [33] Section 3: Changes and Outlook - The U.S. healthcare system is characterized by fragmentation, with high management costs and a significant portion of expenditures directed towards hospitals, which accounted for 30.4% of total healthcare spending in 2022 [47][49] - The growth of Medicare and Medicaid has been rapid, with Medicare expenditures constituting 16.56% of federal spending in 2023, highlighting the increasing financial pressure on the U.S. government [43][43]