医改要向整容业学习

    我们老是会听到这样的说法，市场力量能在汽车、手机和住房等领域为大众带来价格实惠的产品，但在医疗保健领域却从来都不管用。

    据说造成这个谜团的首要原因是每个病人的情况都千差万别，每个疗程也都必须辩证施治，所以医生没法提前决定治疗成本，也没办法告诉病人治疗费用。所以，向病人提供他们可以比较的价格完全行不通。另一个原因是，药物太复杂了，病人没有能力选择费用低、疗效好的方案。第三个原因则是有这么个观点——这跟其他经济领域形成了鲜明对比——即新技术会不可避免地使医疗费用更加昂贵。

    这些常常挂在人们嘴边的说法没有根据。最能说明问题的就是竞争白热化的整容手术和微创治疗技术。

    而一份出自保守派智库“全美政策分析中心”（National Center for Policy Analysis）的最新研究报告表明，医疗保健行业的发展动力其实和其他领域通行的模式无异。这篇报告的作者是经济学家德文•赫瑞克，他在收集并分析了“美国整容外科协会”（American Society of Plastic Surgeons）的年度统计调查数据后，发现了一些非同寻常的趋势。

    过去二十年间，美国的医疗价格——并不是总花费——每年的涨幅约为5%，也就是“居民消费价格指数”（CPI）的两倍。相比之下，整容手术的价格每年仅微涨1.3%，也就是比通胀比率整整低了1.2个百分点。

    之所以会出现这种现象是因为，整容手术要靠病人自己掏钱，这样一来他们就和其他消费者的行为没什么区别了。他们会货比三家，选择性价比最高的方案，同时乐在其中。而在其他医疗领域，医疗成本主要是由第三方、雇主、保险公司或联邦医保和医疗补助计划埋单的。患者每花一美元治疗费，自己只需出11%。因此他们几乎不会有任何动力去寻求最优惠价格。

    这与整容手术的情况恰恰相反：在面部整容或肉毒杆菌注射中省下的钱恰恰是可以花在度假或孩子学费上的。这类医生也会大打折扣来拉生意。像Groupon和LivingSocial这类团购网站经常会推出“每日特惠”的整容手术。赫瑞克发现，肉毒杆菌注射的平均花费已从2007年的500美元降到现在的365美元。

    而美容手术的增长幅度也确实比其他医疗保健项目要大得多。面部整容和抽脂术这类整容手术的总量以年均8%的速度在增长，而像褪毛和蜘蛛静脉激光切除等微创手术 的年均增幅更是高达28%。

    但是，这样的大幅增长并没有带来价格的猛涨。由于竞争激烈，医生必须定价合理。绝大多数这类整容手术都在诊所开展，价格要远低于医院手术室。这方面从业者和相关机构的供给弹性很大——它很好地说明了为什么应该让医疗领域的劳动力像其他领域一样根据市场供需规律来自由流动。

    We're constantly hearing why the market forces that bring us great deals on cars, cellular phones, and houses can never work in health care.

    One leading myth is that each patient is so different, and every procedure so tailored, that doctors can't determine the cost, or tell patients the price, in advance. Hence, providing consumers with prices they can compare is totally impractical. Another holds that medicine is so sophisticated that consumers are incapable of choosing deals that combine low cost with the promise of excellent outcomes. A third is the concept that -- in contrast to every other area of the economy -- new technology inevitably makes everything more expensive.

    Those oft-repeated beliefs are wrong. And the best evidence is the ultra-competitive field of cosmetic surgery and minimally invasive treatments.

    A new paper from conservative think tank the National Center for Policy Analysis, shows just how the industry's dynamics follow the patterns that prevail everywhere else. The author, economist Devon Herrick, collected and analyzed data from the annual statistical surveys of the American Society of Plastic Surgeons, and the trends he has identified are extraordinary.

    Over the past two decades, U.S. medical prices –– not total spending –– have been rising at around 5% per year, or twice the increase in the CPI. By contrast, prices for cosmetic surgery are inching forward at just 1.3% a year, or a full 1.2 percentage points lower than inflation.

    The reason is that patients spend their own money on cosmetic treatments, and in doing so behave just like consumers everywhere else. They shop for the best deals and love doing it. In every other medical field, costs are largely covered by third parties, employers, insurers, or Medicare and Medicaid. Consumers pay just 11 cents for every dollar in care they consume. The rewards for seeking the most favorable prices are nil.

    It's just the opposite in cosmetic surgery: Whatever you can save on a facelift or Botox treatment is money you get to spend on a vacation or your kid's tuition. Doctors compete vigorously to win business using steep discounts. Websites such as Groupon (GRPN) and LivingSocial regularly offer "deals-of-the day" for cosmetic procedures. The average cost of Botox, Herrick found, dropped from $500 in 2007 to $365.

    The growth in cosmetic procedures outstrips virtually every other area of health care. The volume of surgical procedures, such as facelifts and liposuction, is rising at 8% a year, while minimally invasive treatments like hair and spider vein removal with lasers are increasing 28% annually.

    Yet the explosive demand has not been accompanied by big prices. The keen competition forces doctors to prize efficiency. Most of the procedures are conducted in clinics where costs are far lower than in hospital surgery rooms. The supply of practitioners and facilities is highly elastic -- a great argument for why allowing manpower to freely follow the market works in medicine just as everywhere else.