今天我們繼續來了解新加坡醫療制度和美國的一個對比情況。
在本次文章裏《The Cure That Works 》的作者弗林舉例來說明美國費用高昂的來源。
比如他拜訪過的一名醫生，私人診所的醫生，就需要五個人爲其服務，人員多，管理成本就會增長。以及，弗林對比了新加坡醫藥市場和美國醫藥市場，有意思的是新加坡現在使用的相對有效的政策確實美國幾十年前曾用過的，然而經過FDA的改變，使藥價飛漲，人們等的救命藥卡在了FDA的官僚體系裏。
本文內容源自《財富》雜志，後面會附上英文。
新加坡政府會爲貧困人群或者遭遇一些大災難的人提供補助，但和美國不同，這些並不是大預算，因爲自由市場競爭使價格非常合理。競爭也大大降低了管理成本。
弗林解釋了在美國，這些成本是如何飙升的，這些都是由于我們的第三方體系。
他引用了他曾拜訪過的一位專業醫師的例子。
這位醫生是一位個體執業醫師，他安排一個人來處理日程安排和其他例行的辦公室雜務，另外兩個人負責申請那些複雜的保險索賠，並就任何有爭議的賠償問題與保險官員進行談判。他發現：那兩個人也意味著另一方至少還有兩個人。一個醫生會需要有五個人爲其服務。
難怪管理成本總是激增。更糟糕的是，保險公司的利潤取決于索賠量。不像真正的消費市場那樣，這並不是控制支出的一個好動機。在藥物審批方面，新加坡也給我們上了令人深省的一課。任何藥物或設備通常都是可以的，只要它通過了主要外國藥品監管機構的批准，如FDA、歐洲醫藥管理局、澳大利亞藥物管理局、加拿大健康局以及日本藥品和醫療器械管理局。
但有一個問題，和FDA不同，新加坡只要求證明藥物的安全性，而不管其真實的有效性。新加坡證明，達不到宣傳療效的藥物，很快會在市場上失敗。美國的情況也是如此，直到幾十年前FDA的協議被徹底改變。
令人驚訝的是，經驗證明，那些非FDA機構采取的不傷害方法和我們自20世紀60年代以來所采取的方法效果一樣，而且成本更低。FDA極其嚴格、成本高昂、複雜且耗時的方法讓藥價飛漲，且總體上沒有帶來任何積極的益處。
實際上，他們奪走了無數病人的性命，這些病人絕望等待著的救命藥卡在了FDA官僚體系裏。
The Singaporean government does supply subsidies for the indigent or if someone suffers some catastrophe,but unlike in the U.S., these are not budget-busters because free-market competition keeps prices eminently reasonable.
Competition also slashes administrative costs. Flynn explains how these costs rocket upward in the U.S., thanks to our third-party system.
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He cites the example of a specialist he once visited.
The doctor was a solo practitioner who had one person to do the scheduling and other routine office chores,and two other people to file those complicated insurance claims and fight with insurance bureaucrats over any contested reimbursements.His insight: Those two people also mean at least two more people on the other side. Five people for a single physician.
No wonder administrative costs always balloon. Worse, insurance company profits depend on the volume of claims.
That’s not a great incentive to control expenses, the way a real consumer market would.
Singapore also teaches a sobering lesson regarding drug approvals. Any medication or device is generally okay,as long as it has been approved by any of the major foreign drug-regulatory agencies, such as the FDA,the European Medicines Agency, Australia’s Therapeutic Goods Administration, Health Canada and Japan’s Pharmaceuticals & Medical Devices Agency.
But here’s the kicker: Unlike the FDA, Singapore asks only that a drug be proven to be safe, not whether it is actually efficacious.
Singapore demonstrates that a medicine that doesn’t work as advertised will quickly fail in the marketplace.That was also true in the U.S. until FDA protocols were drastically changed decades ago.
Amazingly, and counterintuitively, experience demonstrates that the do-no-harm approach adopted by those non-FDA agencies is as effective and far less costly than what we’ve been doing since the 1960s. The FDA’s immensely rigid, costly, elaborate and time-consuming methods have sent drug prices through the stratosphere, with no overall positive benefit.
In fact, they’ve cost the lives of countless thousands of patients desperately waiting for life-saving medicines stuck in the FDA’s bureaucratic maw.