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Natural Interest Rate and Money Interest Rates 自然利率和货币利率
IF 0.4 Q3 Economics, Econometrics and Finance Pub Date : 2020-11-10 DOI: 10.1515/ev-2019-0028
Ulrich van Suntum
Abstract The long lasting period of declining interest rates raises the question, whether the latter result from a savings glut, from a money glut, or from both. Moreover, it renewed the old question how the natural interest rate should be sensibly defined, and if it could ever fall below the growth rate, thereby causing dynamic inefficiency. The present article contributes to this debate on a pure theoretical base, leaving the empirical issue for other research. In particular, I briefly discuss Böhm-Bawerk’s three causes for the existence of an interest rate in a private barter economy. I argue that the natural interest rate remains a meaningful concept even in an economy with both a public sector and money. From a welfare economic view, it is also preferable above the so-called golden rule, provided the interest rate does not fall below the growth rate. Although the natural interest rate could well get negative by excess saving in principle, this is normally prevented when durable goods like land or precious metals are available for storing private wealth. On the other hand, issuing credit money tends to push the interest rate below its natural level, even in the long run. In order to prevent this, one could either replace it by neutral helicopter money or return to a gold currency.
长期的利率下降引发了一个问题,后者是储蓄过剩的结果,还是货币过剩的结果,还是两者兼而有之。此外,它重新提出了一个老问题,即自然利率应该如何合理地定义,以及自然利率是否会低于增长率,从而导致动态效率低下。本文在纯理论基础上对这一争论做出了贡献,将实证问题留给其他研究。特别是,我简要地讨论了Böhm-Bawerk在私人易货经济中存在利率的三个原因。我认为,即使在一个既有公共部门又有货币的经济体中,自然利率仍然是一个有意义的概念。从福利经济学的角度来看,只要利率不低于增长率,它也比所谓的黄金法则更可取。虽然自然利率在原则上很可能因过度储蓄而变为负值,但当土地或贵金属等耐用品可用于储存私人财富时,这种情况通常是可以避免的。另一方面,即使从长期来看,发行信贷货币往往会将利率压低至自然水平以下。为了防止这种情况发生,人们要么用中立的“直升机撒钱”(helicopter money)来取代它,要么回归金本位。
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引用次数: 2
An Evolutionary Path Towards a European Monetary Fund 迈向欧洲货币基金组织的渐进之路
IF 0.4 Q3 Economics, Econometrics and Finance Pub Date : 2018-12-19 DOI: 10.1515/EV-2018-0012
Gros Daniel
There is no need for Europe to replicate the International Monetary Fund (IMF). The European Stability Mechanism (ESM) can provide the backstop for sovereigns, even without a financial contribution from the IMF. In this sense, the ESM already constitutes to a large extent a ‘European Monetary Fund’. Other IMF activities, such as surveillance and policy coordination should remain with the European Commission, the Eurogroup and other existing bodies. The financial resources of the ESM will be required as a backstop only intermittently, in times of great financial market instability. The need for this will evolve as a function of the nature of financial markets and their cross-border integration. It is not possible to forecast with any precision when the next financial crisis might break out and what form it will take. Any evolution of the ESM should thus aim at enhancing flexibility in its instruments while clarifying its overall mandate (financial stability), rather than changing the details of the rescue mechanism or its institutional structure. The financial stability function of the ESM should be extended to the central institutions of the Banking Union, with an ultimate backstop for the Single Resolution Fund (SRF). Moreover, the ESM should be viewed as the natural instrument for unifying the euro area’s representation in the IMF.
欧洲没有必要复制国际货币基金组织(IMF)。欧洲稳定机制(ESM)可以为主权国家提供支持,即使没有国际货币基金组织的财政贡献。从这个意义上讲,ESM在很大程度上已经构成了一个“欧洲货币基金组织”。IMF的其他活动,如监督和政策协调,应由欧盟委员会(European Commission)、欧元集团(Eurogroup)和其他现有机构负责。只有在金融市场极度不稳定的时候,ESM的金融资源才会被间歇性地用作后盾。这种需求将随着金融市场的性质及其跨境一体化而演变。我们不可能精确地预测下一场金融危机可能何时爆发,以及将以何种形式爆发。因此,ESM的任何演变都应旨在增强其工具的灵活性,同时澄清其总体任务(金融稳定),而不是改变救助机制或其机构结构的细节。ESM的金融稳定职能应扩展至银行业联盟(Banking Union)的中央机构,并为单一处置基金(SRF)提供最终支持。此外,ESM应被视为统一欧元区在IMF中的代表权的天然工具。
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引用次数: 18
The Fairy Tale of Low Inflation in the Euro Area 欧元区低通胀的童话
IF 0.4 Q3 Economics, Econometrics and Finance Pub Date : 2018-09-29 DOI: 10.1515/ev-2018-0025
Martin Hochstein
Abstract There are strong indications that actual consumer inflation in the euro area is understated by official price measures. The exclusion of homeowner shelter costs and inadequate quality adjustments for certain basket items are among the reasons for a potential downward bias in Eurostat's Harmonised Index of Consumer Prices, which would have widespread ramifications not only for consumers but also for the broader economy and financial markets. By focusing on the HICP as a yardstick for its primary objective of medium-term price stability, the European Central Bank relies on a too narrowly defined and error-prone inflation concept.
有强烈的迹象表明,欧元区的实际消费者通胀被官方价格指标低估了。欧盟统计局(Eurostat)的消费者价格协调指数(Harmonised Index of Consumer Prices)可能会出现向下倾斜,这不仅会对消费者产生广泛影响,还会对更广泛的经济和金融市场产生影响,原因之一是排除了房主住房成本,以及某些篮子项目的质量调整不足。欧洲央行将HICP作为衡量中期价格稳定这一主要目标的标准,依赖于一个定义过于狭隘且容易出错的通胀概念。
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引用次数: 1
Food Insecurity and Health Outcomes 粮食不安全与健康后果
IF 0.4 Q3 Economics, Econometrics and Finance Pub Date : 2017-07-08 DOI: 10.1515/ev-2017-0004
Craig Gundersen, H. Seligman
Abstract Food insecurity is increasingly recognized as a major health crisis in the U.S. More than 42 million persons were food insecure in 2015, far higher than the levels preceding the 2007 Great Recession. Decades of research demonstrate that food insecurity diminishes individuals’ overall well-being. The recognition of food insecurity as a health crisis, however, stems from a more recent appreciation of the multiple negative health outcomes and, thus, higher health care costs, attributable to food insecurity. An extensive literature from multiple fields, including agricultural economics, economics, medicine, and nutrition, has emerged in recognition of food insecurity as a health crisis. Among other findings, food insecurity among children is associated with increased risks of some birth defects, anemia, lower nutrient intakes, cognitive problems, and aggression and anxiety. Food insecurity is also associated with higher risks of being hospitalized, poorer general health, worse oral health and with having asthma, behavioral problems, depression, and suicidal ideation. For adults, studies have shown that food insecurity is associated with decreased nutrient intakes; increased rates of mental health problems (including depression), diabetes, hypertension, and hyperlipidemia; being in poor or fair health; and poor sleep outcomes. Food insecurity and poor health are likely linked bi-directionally; that is, it is true both that living in a food insecure household predisposes an individual to poor health, and that poor health predisposes one to living in a food insecure household. After describing how food insecurity is measured, we turn to the multiple causes of food insecurity and potential pathways through which food insecurity leads to these negative health outcomes. Finally, we describe two recently articulated interventions designed to address both food insecurity and its health impact. The first is a targeted increase in benefit levels for supplemental nutrition assistance program (SNAP, formerly known as the Food Stamp Program) enrollees and near eligible households, and the second provides tailored support for food insecure individuals with diabetes.
摘要粮食不安全日益被认为是美国的一场重大健康危机。2015年,超过4200万人粮食不安全,远高于2007年大衰退前的水平。几十年的研究表明,粮食不安全会降低个人的整体幸福感。然而,人们认识到粮食不安全是一场健康危机,这源于最近人们对粮食不安全造成的多重负面健康后果的认识,从而导致医疗保健成本上升。来自农业经济学、经济学、医学和营养学等多个领域的大量文献承认粮食不安全是一场健康危机。在其他研究结果中,儿童的粮食不安全与一些出生缺陷、贫血、营养摄入减少、认知问题以及攻击性和焦虑的风险增加有关。食物不安全还与住院风险更高、总体健康状况较差、口腔健康状况较差以及哮喘、行为问题、抑郁症和自杀意念有关。对于成年人来说,研究表明,粮食不安全与营养摄入减少有关;心理健康问题(包括抑郁症)、糖尿病、高血压和高脂血症的发病率增加;健康状况不佳或尚可;以及睡眠不良。粮食不安全和健康状况不佳可能是双向联系的;也就是说,生活在粮食不安全的家庭中会使个人的健康状况不佳,而健康状况不佳会使人生活在粮食没有安全保障的家庭中。在描述了如何衡量粮食不安全之后,我们转向了粮食不安全的多种原因,以及粮食不安全导致这些负面健康结果的潜在途径。最后,我们介绍了最近阐明的两项干预措施,旨在解决粮食不安全及其对健康的影响。第一个是有针对性地提高补充营养援助计划(SNAP,前身为食品券计划)参保者和接近符合条件的家庭的福利水平,第二个是为患有糖尿病的粮食不安全个人提供量身定制的支持。
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引用次数: 9
The Economists’ Voice: Special Issue on Nutrition and Poverty Introduction 经济学家的声音:营养与贫困专题介绍
IF 0.4 Q3 Economics, Econometrics and Finance Pub Date : 2017-06-28 DOI: 10.1515/ev-2017-0010
M. Cragg, J. Stiglitz
Americans spend billions of dollars a year fueling enormous commercial agricultural operations to plant more crops than we need, while tens of millions of Americans – and a huge number of American children – live tenuously close to hunger. Millions more are kept from the brink by our Supplemental Nutrition Assistance Program, or SNAP, that provides a paltry $4.13 per person each day.1 Having a two-headed policy that addresses production and consumption is necessary. Just having a bounteous supply does not ensure each American will be fed. And just giving poor Americans money to buy food does not ensure they can or will do so. However, when the end result is that we produce far more food than we need, because of subsidies, whilemillions of our citizens both have inadequate food on the table and suffer from nutrition-related diseases in epidemic proportions, there is clearly a problem in need of an urgent solution. Post-depression-era farm subsidies made sense because they relieved farmers’ poverty, allowing them to keep producing food so that the nation could feed itself. The 21st century is not the 1930s. While many might nostalgically think of the family farmer in overalls and a straw hat, the vast majority of farm subsidies go to a small number of very large American corporations and conglomerates that wield disproportionate political power. Modern subsidies do not tackle modern dietary problems and, in fact, exacerbate the health problems associated with Americans’ distorted diets. These dietary distortions have had devastating consequences, especially in low-income areas: exploding obesity rates, increasing rates of Type 2 diabetes, and declining learning outcomes. Dietary inequality is a factor that reduces quality of life amongst those most affected by income inequality. Poor nutrition is a cause of the epidemic level of diabetes2 and other poor health outcomes. The food paradox is that we collectively spend huge amounts on farm subsidies, yet many citizens do not have access to high-quality, nutritious food. We collectively spend huge amounts on healthcare, yet our health outcomes, particularly for those living in poverty, are a national emergency. A chain of poor policy choices is exacerbating inequality. One of our main anti-poverty efforts is SNAP (modern-day food stamps). Despite providing only $125.50 per person permonth,3 the Center on Budget and Policy Priorities estimates that SNAP kept 10.3 million Americans out of poverty in 2012.4 However, a two-person household receiving SNAP benefits and a $7.25 per hour minimum wage job is still below the poverty line, and more so if that income is the sole source for a family of four or more.5 We clearly need a stronger food stamp program and more rational subsidies for food production. Stagnant minimumwages with rising costs of living magnifies the health and human development problems associated with poor access to nutrition. Budget constraints and thework requirement to obtain benefits6 h
美国人每年花费数十亿美元资助大规模的商业农业运营,以种植比我们需要的更多的作物,而数以千万计的美国人——以及大量的美国儿童——生活在饥饿的边缘。我们的补充营养援助计划(SNAP)使数百万人免于陷入困境,该计划每天为每人提供微不足道的4.13美元。1有必要制定一项解决生产和消费问题的双头政策。仅仅拥有充足的粮食供应并不能确保每个美国人都能吃饱饭。仅仅给贫困的美国人钱购买粮食也不能确保他们能够或将要做到这一点。然而,当最终结果是,由于补贴,我们生产的粮食远远超过了我们的需求时,而我们的数百万公民既没有足够的粮食,又患有与营养相关的流行病,显然有一个问题急需解决。后萧条时代的农业补贴之所以有意义,是因为它们减轻了农民的贫困,使他们能够继续生产粮食,从而使国家能够养活自己。21世纪不是20世纪30年代。虽然许多人可能会怀念穿着工作服、戴着草帽的家庭农场主,但绝大多数农业补贴都流向了少数拥有不成比例政治权力的美国大公司和企业集团。现代补贴并不能解决现代饮食问题,事实上,它加剧了与美国人扭曲饮食相关的健康问题。这些饮食扭曲产生了毁灭性的后果,尤其是在低收入地区:肥胖率激增,2型糖尿病发病率上升,学习成绩下降。饮食不平等是降低受收入不平等影响最严重人群生活质量的一个因素。营养不良是糖尿病流行水平2和其他不良健康结果的原因之一。粮食悖论是,我们集体在农业补贴上花费了巨额资金,但许多公民却无法获得高质量、营养丰富的食物。我们共同在医疗保健上花费了巨额资金,但我们的健康结果,特别是对那些生活在贫困中的人来说,是一个国家紧急情况。一连串糟糕的政策选择正在加剧不平等。我们的主要扶贫工作之一是SNAP(现代食品券)。尽管每人每月仅提供125.50美元,3预算和政策优先中心估计,2012年SNAP使1030万美国人摆脱了贫困。4然而,一个领取SNAP福利和每小时7.25美元最低工资工作的两人家庭仍低于贫困线,如果收入是一个四口或四口以上家庭的唯一来源,情况就更糟了。5我们显然需要更强有力的食品券计划和更合理的食品生产补贴。最低工资停滞不前,生活成本不断上涨,加剧了与营养缺乏相关的健康和人类发展问题。预算限制和获得福利的工作要求6减少了SNAP申请者的数量和每个申请者的平均每月福利。7一直以来,三分之一的成年人肥胖,10%的成年人患有糖尿病。8我们该何去何从?《经济学家之声》的这期特刊聚焦于营养和贫困之间的相互作用,它们之间的关系,以及我们能做些什么。我们的目标是为经济学家、立法机构和政策制定者提供最相关的信息和分析,供他们在我们的社会努力解决粮食安全、质量和负担能力等复杂问题时考虑,尤其是在我们最脆弱的人群中。本版提供了倡导经济和营养政策的论文,这些政策可以为低收入美国人提供最大帮助,包括改善SNAP和妇女、婴儿和儿童特别补充营养计划,提高最低工资,为更健康的食品提供价格激励,提供营养教育,改革我们的税收和补贴制度,鼓励人们选择更好的食物。政策制定者必须认识到短视的迎合农业综合企业游说所产生的巨大长期健康成本之间的相互作用。
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引用次数: 0
Ensuring Access to Fruits and Vegetables for the Nation’s Most Vulnerable – Contributions of WIC and SNAP 确保国家最弱势群体获得水果和蔬菜——WIC和SNAP的贡献
IF 0.4 Q3 Economics, Econometrics and Finance Pub Date : 2017-05-25 DOI: 10.1515/ev-2017-0005
D. Herman
Abstract The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP) are critical programs in the U.S. because they form the basis of the nation’s nutrition and hunger safety net. SNAP has large effect nationwide offering nutrition assistance to 1 in 7 low-income Americans, while WIC serves more than half of all infants in the U.S. and a quarter of all children ages 1-5 years. Despite the reach of these programs, there is still room for improvement, especially when it comes to increasing access to healthy food items and improving eating habits. The objective of this paper is to make recommendations for how WIC and SNAP can work better together to continue to incentivize purchases and support low-income population’s knowledge and access to healthier food choices, particularly those foods that have traditionally been most expensive – fruits and vegetables.
摘要妇女、婴儿和儿童特别补充营养计划(WIC)和补充营养援助计划(SNAP)是美国的关键计划,因为它们构成了国家营养和饥饿安全网的基础。SNAP在全国范围内发挥了巨大作用,为七分之一的低收入美国人提供营养援助,而WIC为美国一半以上的婴儿和四分之一的1-5岁儿童提供服务。尽管这些计划的范围很广,但仍有改进的空间,尤其是在增加健康食品的获取和改善饮食习惯方面。本文的目的是就WIC和SNAP如何更好地合作提出建议,以继续激励购买,支持低收入人群了解和获得更健康的食物选择,特别是那些传统上最昂贵的食物——水果和蔬菜。
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引用次数: 2
Poverty and Obesity as Political Indicators 贫穷和肥胖作为政治指标
IF 0.4 Q3 Economics, Econometrics and Finance Pub Date : 2017-01-01 DOI: 10.1515/ev-2017-0006
A. Drewnowski
Abstract Obesity in the US is treated as a medical condition, while its socioeconomic roots are all but ignored. Yet obesity was a univariate predictor of voting patterns in the 2016 presidential election at both state and county level. Health indicators, linked to socioeconomic variables, may be the new political force.
在美国,肥胖被视为一种疾病,而其社会经济根源却几乎被忽视。然而,在2016年的总统大选中,肥胖是州和县两级投票模式的单变量预测因素。与社会经济变量相关的健康指标可能成为新的政治力量。
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引用次数: 0
Caloric Sweetened Beverage Taxes: A Toothless Solution? 含热量饮料税:无牙解决方案?
IF 0.4 Q3 Economics, Econometrics and Finance Pub Date : 2017-01-01 DOI: 10.1515/ev-2017-0009
E. Cohen, Jehan deFonseka, R. Mcgowan
Abstract We lay out a framework for assessing if calorie sweetened beverage taxes are effective, and, concluding they are not, provide recommendations for better solutions. Similar taxes, known as sin taxes, generally have three specific goals: 1) to lower consumption of the offending substance or activity; 2) to minimize the black market; and 3) to generate government revenues. We find that on the whole, caloric sweetened beverage taxes fail to meet each of the criteria for effective sin taxes. They neither meaningfully lower consumption of caloric sweeteners generally, nor do they provide for a healthier alternative. They are straightforward to geographically circumvent, and there are many carve outs which are not taxed, dampening the impact they could have on the consumption of caloric sweeteners. Although these taxes are potentially a significant source of tax revenue, such collections are largely and disproportionately borne by the poor. Instead, we propose enacting a broad policy on a national level consisting of three components: 1) removing government support for caloric sweeteners, 2) levying a federal excise tax on caloric sweeteners at the producer level, and 3) investing in research, implementation of significant subsidies, and development and transmission of explicit government advice in favor of foods that are irrefutably beneficial for the vast majority of human beings.
我们提出了一个框架来评估卡路里加糖饮料税是否有效,并得出结论,他们不是,提供更好的解决方案的建议。类似的税,被称为罪恶税,通常有三个具体目标:1)减少对犯罪物质或活动的消费;2)尽量减少黑市;3)增加政府收入。我们发现,总的来说,含热量饮料税不符合有效罪恶税的每一个标准。它们既不能有效地降低热量甜味剂的消耗,也不能提供更健康的替代品。它们在地理上很容易被规避,而且有许多免税产品是不征税的,这削弱了它们对高热量甜味剂消费的影响。虽然这些税收可能是税收收入的重要来源,但这些税收主要由穷人承担,而且比例不成比例。相反,我们建议在国家层面制定一项广泛的政策,包括三个组成部分:1)取消政府对高热量甜味剂的支持,2)在生产商层面对高热量甜味剂征收联邦消费税,以及3)投资研究,实施重大补贴,开发和传播明确的政府建议,支持对绝大多数人有益的食品。
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引用次数: 0
Parents' Perceptions of and Responses to Children's Emotions: Relations with Meta-Emotion Philosophy and Adult Attachment. 父母对子女情绪的看法和反应:元情感哲学与成人依恋的关系。
IF 2.2 Q4 ECONOMICS Pub Date : 2017-01-01 Epub Date: 2017-05-02 DOI: 10.1080/15295192.2017.1304782
Jennifer N Morey, Amy L Gentzler

Objective: This study investigated how parents' perceptions of, feelings toward, and anticipated responses to children's emotions relate to parents' meta-emotion philosophy (MEP) and attachment.

Design: Parents (112 mothers and 95 fathers) completed an online research study where they viewed photographs of unfamiliar girls and boys (aged 10 to 14 years) displaying varying intensities of happiness, sadness, fear, anger, and neutral expressions. Parents labeled the emotion, identified the emotion's intensity, and reported their mirrored emotion and responses. They also completed measures assessing their MEP and attachment.

Results: MEP predicted parents' responses to children's negative emotion, in that greater emotion-coaching predicted greater accuracy in labeling emotions (boys only), a greater likelihood to interact with children, and for mothers to be further from the mean in either direction in their mirrored emotion. Attachment also predicted parents' responses to children's negative emotions: Parents higher in anxiety reported more mirrored emotion, and those higher in avoidance reported less mirrored emotion, lower intensity, and less willingness to interact (boys only). In exploratory models for positive emotion, parents' MEP did not predict their responses, but parents higher in attachment avoidance rated girls' positive emotions as less intense, reported less mirrored emotion, less willingness to interact, and less supportive responses, and those higher in anxiety showed the opposite pattern.

Conclusions: Despite methodological limitations, results offer new evidence that parents' ratings on a standardized emotion perception task as well as their anticipated responses toward children's emotion displays are predicted by individual differences in their attachment and MEP.

研究目的本研究调查了父母对儿童情绪的认知、感受和预期反应与父母的元情绪哲学(MEP)和依恋的关系:父母(112 位母亲和 95 位父亲)完成了一项在线调查研究,他们观看了一些陌生女孩和男孩(10 至 14 岁)的照片,这些照片表现出不同强度的快乐、悲伤、恐惧、愤怒和中性表情。家长们给情绪贴上标签,确定情绪的强度,并报告自己的镜像情绪和反应。他们还完成了评估其 MEP 和依恋的测量:MEP可预测父母对孩子负面情绪的反应,因为情绪辅导越多,预测父母标记情绪的准确性越高(仅限于男孩),与孩子互动的可能性越大,母亲的镜像情绪在两个方向上离平均值越远。依恋也能预测父母对孩子负面情绪的反应:焦虑程度较高的父母反映出更多的镜像情绪,而回避程度较高的父母则反映出较少的镜像情绪、较低的强度和较少的互动意愿(仅限于男孩)。在积极情绪的探索性模型中,父母的 MEP 并不能预测他们的反应,但依恋回避程度较高的父母对女孩积极情绪的评价较低,报告的镜像情绪较少,互动意愿较低,支持性反应较少,而焦虑程度较高的父母则表现出相反的模式:尽管存在方法上的局限性,但研究结果提供了新的证据,即父母在标准化情绪感知任务中的评分以及他们对子女情绪表现的预期反应,是由他们的依恋和依恋回避的个体差异所预测的。
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引用次数: 0
Are Biopharmaceutical Budget Caps Good Public Policy? 生物制药预算上限是好的公共政策吗?
IF 0.4 Q3 Economics, Econometrics and Finance Pub Date : 2016-12-01 DOI: 10.1515/ev-2015-0012
D. Goldman, D. Lakdawalla, J. Baumgardner, M. Linthicum
Abstract Medical innovation has generated significant gains in health over the past decades, but these advances have been accompanied by rapid growth in healthcare spending. Faced with a growing number of high-cost but high-impact innovations, some have argued to constrain prices for new therapies – especially through global caps on pharmaceutical spending and limits on prices for individual drugs. We show that applying this threshold to past innovations would have limited access to many highly valuable drugs such as statins and anti-retrovirals. We also argue that budget caps violate several important principles of health policy. First, budget caps treat healthcare spending as a consumption good, like going to a movie or buying a meal. However, healthcare spending should be viewed as an investment, whose benefits accrue over many years – much like spending on education. Second, budgetary cost is a poor indicator of value, thereby distorting coverage decisions. Third, affordability arguments often use a short-term horizon, thereby missing that long-term health is society’s ultimate goal. Fourth, assessments of benefit should incorporate not just the immediate clinical benefit to patients, but also long-term health improvements, cost savings, and increased productivity. Fifth, global budget caps arbitrarily anchor spending on the status quo, thereby setting too stringent a threshold for socially-desirable innovation. In sum, a solitary focus on short-term costs can be detrimental to population health in the long-run. When medical treatment decisions are properly viewed as investments, budget caps are not the answer; rather, we need to find mechanisms to encourage spending decisions based on long-term value. Only then can we generate health returns to societal investments, while also encouraging the new research and development necessary to extend the gains of recent decades.
在过去的几十年里,医疗创新在健康方面取得了显著的进步,但这些进步伴随着医疗支出的快速增长。面对越来越多的高成本但高影响的创新,一些人主张限制新疗法的价格——特别是通过全球药费上限和个别药物价格限制。我们表明,将这一阈值应用于过去的创新将限制许多高价值药物的获取,如他汀类药物和抗逆转录病毒药物。我们还认为,预算上限违反了卫生政策的几项重要原则。首先,预算上限将医疗支出视为一种消费商品,就像去看电影或吃饭一样。然而,医疗支出应该被视为一种投资,其收益需要多年积累,就像教育支出一样。其次,预算成本是一个很差的价值指标,从而扭曲了覆盖范围的决定。第三,可负担性的论点往往使用短期视角,从而忽略了长期健康是社会的最终目标。第四,效益评估不仅应包括对患者的直接临床效益,还应包括长期健康改善、成本节约和生产力提高。第五,全球预算上限武断地将支出固定在现状上,从而为社会期望的创新设定了过于严格的门槛。总而言之,从长远来看,只注重短期费用可能对人口健康有害。当医疗决策被恰当地视为投资时,预算上限就不是答案;相反,我们需要找到机制,鼓励基于长期价值的支出决策。只有这样,我们才能为社会投资带来健康方面的回报,同时鼓励扩大近几十年来取得的成果所必需的新研究和发展。
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