平成年度

29

RESEARCH REPORT 2018.03

医療経済研究機構自主研究事業

平 成 2 9 年 度 医 療 経 済 研 究 機 構自主 研 究 事 業

ア メ リ カ 医 療 関 連 デ ー タ 集︻ 2 0 1 7 年 度 版 ︼アメリカ医 療 関 連デ ータ集【2017年度版】
研究代表者

アメリカ医療関連データ集製作委員会
平成30年3月

Medical

平成年3月

30

Care

International

Others࢔࣓ࣜ࢝་⒪㛵㐃ࢹ࣮ࢱ㞟〇సጤဨ఍ጤဨ㛗すᮧ ࿘୕㸦་⒪⤒῭◊✲ᶵᵓ࣭ᡤ㛗㸧ጤဨ▼⏣ 㐨ᙪ㸦㔠ἑ኱ᏛἲᏛ㢮࣭ᩍᤵ㸧ጤဨὠᕝ ཭௓㸦࢝ࣜࣇ࢛ࣝࢽ࢔኱Ꮫࣟࢧࣥࢮࣝࢫᰯ࣭ຓᩍᤵ㸧ጤဨ㛗㇂ᕝ༓᫓㸦❧࿨㤋኱Ꮫ⏘ᴗ♫఍Ꮫ㒊࣭෸ᩍᤵ㸧ጤဨᒣᓊ ᩗ࿴㸦༡ᒣ኱Ꮫᅜ㝿ᩍ㣴Ꮫ㒊࣭ᩍᤵ㸧࢔ࢻࣂ࢖ࢨ࣮୸ᒣ ្㸦ཌ⏕ປാ┬㸧஦ົᒁᒣᒸ ῟㸦་⒪⤒῭◊✲ᶵᵓ࣭୺௵◊✲ဨ㸧஦ົᒁ㏆⸨ග㔞㸦་⒪⤒῭◊✲ᶵᵓ࣭◊✲ဨ㸧     ᡤᒓࡣ  ᖺ  ᭶⌧ᅾᮏሗ࿌᭩ࡢ୍㒊ࡲࡓࡣ඲㒊ࢆၥࢃࡎࠊ↓᩿ᘬ⏝ࠊ㌿㍕ࢆ⚗ࡎࡿࠋ࢔࣓ࣜ࢝་⒪㛵㐃ࢹ࣮ࢱ㞟࠙ ᖺᗘ∧ࠚࠓ⥲┠ḟࠔ࣮࣌ࢪቿኾ዇ኈ⦌␔ቑ㦏扠ቑ╤ሰ                                                    

䶻ൕ捷 ◊䣑栱抲ኤዙኜᇻ ㄃ㄵ䓗ᇼ                                         ⅉ♲ዘⅉ♲╤㏚ 俛䂗㖖㲨 ◊䣑彊ዘ䯍↩≬椫彊 ◊䣑≬椉 ◊䣑㙟∪⇢Ⓟ ◊堻❐ዘ◊䣑㧟㠨ዘ◊䣑㳮⣷ ◊䣑栱抲倀岗 ㍔⫀ኒኁእ
䶻ൖ捷 ◊䣑≬椫Ⓟㄵ屲崻ᇻ ㄃ㄵ䓗ᇼ                                     ◊䣑≬椫Ⓟㄵቑ㰑尐 ◊䣑㟎䷥ቑ㟎㽊拝䲚ቋ栱抲⥲⇢᧤⼀⽇㟻✛Ᵽ❰᧥ ◊䣑㙟∪⇢Ⓟ᧤㾴ぬ♚⅚Ᵽ❰᧥ ⏻䤓◊䣑≬椉Ⓟㄵኾኤኀ኎ቿ᧤䪂䞿拢ㇵⱣ❰᧥ ⏻䤓◊䣑≬椉Ⓟㄵኾኤኀ኎ኁኦ᧤䪂䞿拢ㇵⱣ❰᧥ ⏻䤓◊䣑≬椉Ⓟㄵね⏟䵴◊䣑≬椉ኴዊኍ዆ኽ᧤&+,3᧥᧤䪂䞿拢ㇵⱣ❰᧥ 㺠栢◊䣑≬椉᧤栆廆ぬ◒㢴Ᵽ❰᧥ 䎰≬椉劔᧤栆廆ぬ◒㢴Ᵽ❰᧥

䶻ൗ捷 扠㄃ቑ╤⚠ᇻ ㄃ㄵ䓗ᇼ                                        ኇክኻ኎ቿቑ㎞券ቋ㸚ሸቯቂ嵁櫛᧤⼀⽇㟻✛Ᵽ❰᧥ እ዆ዐኴ㟎㲸ₚ቎ርሴቮ◊䣑Ⓟㄵ㟈槸ቑ尚抩ሺ᧤㾴ぬ♚⅚Ᵽ❰᧥ ኾኤኀ኎ቿቑ峉䣑⫀揻㟈槸ቋ堻∰⺍䷥᧤䪂䞿拢ㇵⱣ❰᧥ 䞲㯼ዘ楖䞷㱚抯ቑ⮘▥ቋ◊䣑≬椫᧤栆廆ぬ◒㢴Ᵽ❰᧥ ቿኾ዇ኈቑᇷኺ኱ዂዉዙኔዄዐዘኵወኖᇸ㡌䷥ቑ㦏扠ቑ╤⚠᧤導㧠⛷ₘⱣ❰᧥᧩ቿኾ዇ኈ⦌␔ቑ㦏扠ቑ╤ሰ᧩᧪㟎㽊㍔╱ ᖺ  ᭶  ᪥࡟➨  ௦኱⤫㡿࡜ࡋ࡚ࢻࢼࣝࢻ࣭ࢺࣛࣥࣉẶࡀᑵ௵ࡋࡓࠋ኱⤫㡿㑅ᣲ࡜᫬ࢆྠࡌ
ࡃࡋ࡚ᐇ᪋ࡉࢀࡓୖୗ㝔㑅ᣲ࡛ࡣࠊඹ࡟ඹ࿴ඪࡀከᩘὴ࡜࡞ࡾࠊ㆟఍࡜኱⤫㡿㛫࡟࠾ࡅࡿᨻඪࡢࡡࡌࢀࡣゎᾘࡋࡓࠋࡓࡔࠊ୧㝔࡟࠾ࡅࡿᩘⓗඃ఩ࡣ኱ࡁࡃ࡞࠸ࡓࡵ㸦ୖ㝔 >ᐃဨ @ࠊୗ㝔 >ᐃဨ @ࠊ ᖺ  ᭶⌧ᅾ㸧ࠊᚲࡎࡋࡶඹ࿴ඪࡀ┙▼࡜࠸࠺ࢃࡅ࡛ࡣ࡞࠸ࠋ⌧࡟ࢺࣛࣥࣉ኱⤫㡿ࡀබ⣙ࡢ୍ࡘ࡜ࡋ࡚ᥖࡆࡓ་⒪ಖ㝤ไᗘᨵ㠉ἲ㸦࢜ࣂ࣐ࢣ࢔㸧ࡢ᧔ᗫἲ᱌ࡣࠊᗄᗘࡢಟṇ࡟ࡶ࠿࠿ࢃࡽࡎࠊୖ㝔ඹ࿴ඪ㆟ဨᩘྡࡢ཯ᑐ࡟ࡼࡾᡂ❧ࡋ࡞࠿ࡗࡓࠋࢺࣛࣥࣉ㝕Ⴀࡣࠊ ᖺࡢ኱⤫㡿㑅ᣲ࡟࠾ࡅࡿࣟࢩ࢔ࡢ㑅ᣲᖸ΅࡬ࡢ㛵୚ࡀ␲ࢃࢀࠊ⡿㐃㑥ᤚᰝᒁ㸦)%,㸧࡟ࡼࡿᤚᰝࡀ⥅⥆ࡉࢀ࡚࠸ࡿࠋྠ኱⤫㡿ࡢᨭᣢ⋡࡟ࡘ࠸࡚ࡣࠊ&11 ࡀ⮬㌟ࡢ᭱ప್  ࡜୪ࢇࡔ࡜ሗࡌࡿ୍᪉࡛ࠊ5DVPXVVHQ ࡢ᪥ሗ࡛ࡣᨭᣢ⋡ ࡟㏆࡙ࡁࠊྠ᫬ᮇࡢ࢜ࣂ࣐኱⤫㡿ࢆᢤ࠸ࡓ࡜ሗࡌࡽࢀࡿ࡞࡝ࠊࡑࡢ್ཬࡧホ౯ࡣㄪᰝ୺యཬࡧ࣓ࢹ࢕࢔࡟ࡼࡾ␗࡞ࡗ࡚࠸ࡿࡢࡀ⌧≧࡛࠶ࡿ㸦ࢺࣛࣥࣉᨻᶒᨭᣢ⋡ࡢ᪥ሗ࡜ࡋ࡚ *DOOXS࡜ 5DVXPXVVHQ࡟ࡼࡿሗ࿌ࡀ࠶ࡿࠋ㸧ࠋḟࡢ୰㛫㑅ᣲࡣ  ᖺ ᭶࡟ணᐃࡉࢀ࡚࠾ࡾࠊඹ࿴ඪࡀᘬࡁ⥆ࡁ୧㝔ከᩘὴࢆ༨᭷࡛ࡁࡿ࠿ࠊࡑࡢ⤖ᯝࡀὀ┠ࡉࢀࡿࠋ᧪俛䂗㍔╱ ᖺࠊ⡿ᅜࡢ *'3 ࡣᑐ๓ᖺẚ ࡛ᡂ㛗ࡋࠊ1< ࢲ࢘ᖹᆒᰴ౯ࡣ㸰୓  ࢻࣝࢆ㉸࠼ࠊ ᖺึ㢌࡟ࡣ㐣ཤ᭱㧗್ࢆ᭦᪂ࡋࡓࠋ㞠⏝᝟ໃࡶࠊኻᴗ⋡ࡀ 㸣࡜㐣ཤ᭱పỈ‽ࡲ࡛పୗࡋࠊ⡿㐃㑥‽ഛ⌮஦఍㸦)5%㸧ࡶ᭱᪂ࡢ㆟఍ሗ࿌᭩࡟࠾࠸࡚ࠕ᏶඲㞠⏝࡟㏆࠸ࡶࡋࡃࡣࡸࡸ㉸࠼࡚࠸ࡿࠖ࡜ࡢぢゎࢆ♧ࡋ࡚࠸ࡿࠋ㔞ⓗ⦆࿴ᨻ⟇ࢆ୺ᑟࡋ࡚ࡁࡓ )5% ࡢ㆟㛗ࡣ  ᮇ  ᖺ௨ୖࡘ࡜ࡵࡿࡢࡀ㏻౛࡛࠶ࡗࡓࡀࠊ
ࢺࣛࣥࣉẶࡣ࢖࢚ࣞࣥẶࢆ෌௵ࡉࡏࡎࠊ⌮஦࡛࠶ࡗࡓࣃ࢚࢘ࣝẶࢆࡑࡢᚋ௵࡜ࡋ࡚ᣦྡࡋࡓࠋྠẶࡣඹ࿴ඪဨ࡛࠶ࡾࠊᨻᶒࡢ࣮࢝ࣛࢆฟࡏࡿ࡜ྠ᫬࡟ࠊ࢖࢚ࣞࣥ㆟㛗᫬௦ࡢ㔠⼥ᨻ⟇ࢆᘬࡁ⥅ࡄ࡟ࡣ᭱㐺
1

Patient Protection and Affordable Care Actࠊ㏻⛠ ACA

2

CNN グ஦ https://www.cnn.com/2018/02/25/politics/cnn-poll-trump-approval-matches-low/index.html [2018 ᖺ 3 ᭶ 1 ᪥࢔ࢡࢭࢫ]3Newsweek グ஦ http://www.newsweek.com/donald-trump-approval-rating-higher-823037 [2018 ᖺ 3 ᭶ 1 ᪥࢔ࢡࢭࢫ]4

Gallup ♫࢙࢘ࣈࢧ࢖ࢺ http://news.gallup.com/poll/201617/gallup-daily-trump-job-approval.aspx

5

Rasumussen ♫࢙࢘ࣈࢧ࢖ࢺ
http://www.rasmussenreports.com/public_content/politics/trump_administration/trump_approval_index_history6

IMF ࢙࢘ࣈࢧ࢖ࢺ http://www.imf.org/external/datamapper/NGDP_RPCH@WEO/USA?year=2018

7

FRB ࢙࢘ࣈࢧ࢖ࢺ Monetary Policy Report – February 2018https://www.federalreserve.gov/monetarypolicy/2018-02-mpr-summary.htm

-1--1-ࡢே㑅࡛࠶ࡗࡓ࡜࠸࠼ࡿࠋ୍᪉࡛ࠊ⛯ไᨵ㠉ἲ᱌ࡀ  ᖺᮎ࡟ୖୗ㝔ࢆ㏻㐣ࡋࠊ⡿ᅜࡣ኱ᖜ࡞ῶ⛯࡟㋃ࡳษࡗࡓࠋ኱௻ᴗ࣭ᐩ
⿱ᒙඃ㐝࡜ゝࢃࢀ࡚࠸ࡿᮏῶ⛯ࡀࠊ࡝ࡢ⛬ᗘ⡿ᅜ⤒῭ࢆᢲࡋୖࡆࡿ࠿ࡣ୙☜࠿࡛࠶ࡿࠋࡲࡓࠊ኱ᖜῶ⛯࡟ࡼࡾ㐃㑥ᨻᗓࡢ㈈ᨻᝏ໬ࡣ㑊ࡅࡽࢀࡎࠊ ᖺ  ᭶࡟Ⓨ⾲ࡋࡓ࢖ࣥࣇࣛᢞ㈨ィ⏬ࡶࠊ ࢝ᖺ࡛ ඙ࢻࣝ࡜ᙜึࡼࡾ኱つᶍ࡞ࡶࡢ࡜࡞ࡗࡓࡀࠊࡑࡢ࠺ࡕ㐃㑥ᨻᗓࡢᨭฟศࡀ  ༓൨ࢻࣝ࡟࡜࡝ࡲࡾࠊṧࡾࡣᕞᨻᗓࠊᆅ᪉⮬἞యࡢฟ㈨࡟ᮇᚅࡍࡿෆᐜ࡛࠶ࡗࡓࡇ࡜࠿ࡽࠊ᪤࡟཯ㄽࡸࠊࡑࡢᐇຠᛶ࡟␲ၥࡀ࿊ࡉࢀ࡚࠸ࡿࡼ࠺࡛࠶ࡿࠋ)5% ࡣࠊ⤒῭ᡂ㛗࡜ࣂࣛࣥࢫࢆ࡜ࡾ࡞ࡀࡽࠊᙜ㠃⦆ࡸ࠿࡞㈨⏘⦰ᑠཬࡧ฼ୖࡆࢆ⥅⥆ࡋ࡚࠸ࡃ࡜ࡢࡇ࡜࡛࠶ࡾࠊ௒ᚋࡢᑐᛂࡀὀどࡉࢀࡿࠋ3᧪◊䣑㟎䷥㍔╱
๓㏙ࡢ࡜࠾ࡾࠊ࢜ࣂ࣐ࢣ࢔᧔ᗫἲ᱌ࡣࠊୖ㝔࡛ࡢ཯ᑐ࡟ࡼࡾᡂ❧ࡋ࡞࠿ࡗࡓࠋࡋ࠿ࡋࠊ ᖺᮎ࡟㏻㐣ࡋࡓ⛯ไᨵ㠉ἲ᱌࡟ࡣࠊ࢜ࣂ࣐ࢣ࢔࡛ᑟධࡉࢀࡓ LQGLYLGXDOPDQGDWH㸦ಶே࡬ࡢ་⒪ಖ㝤ຍධ⩏ົ㸧࡛ࡢ⨩๎㔠ࡢ᧔ᗫࡀྵࡲࢀ࡚࠾ࡾࠊྠ⩏ົࡣ஦ᐇୖ↓ຠ໬ࡉࢀࡿࡇ࡜࡜࡞ࡗࡓ㸦 ᖺᗘࡼࡾⓎຠ㸧ࠋ㆟఍ண⟬ᒁ㸦&%2㸧ࡢ᥎ィ࡟ࡼࢀࡤࠊࡇࡢඛ  ᖺ࡟Ώࡾ㐃㑥ண⟬ࡀ  ൨ࢻࣝ๐ῶ㸦ಖ㝤ࢆ㉎ධࡍࡿ⪅ࡀῶᑡࡍࡿࡇ࡜࡟ࡼࡿ⿵ຓ㔠ࡢῶᑡ➼㸧ࡉࢀࡿ୍᪉࡛ࠊ ᖺ࡟ࡣ↓ಖ㝤⪅ࡀ⣙  ୓ே
ቑຍࡋࠊH[FKDQJH ᕷሙ࡟࠾࠸࡚ᖺ⋡⣙ ࡢಖ㝤ᩱ㧗㦐ࡀணࡉࢀ࡚࠸ࡿࠋ ⡿ᅜࡢᑐ *'3 ẚಖ೺་⒪ᨭฟࡣࠊୡ⏺ࡢ୰࡛ࡶ୍Ṍ✺ฟࡋࡓ≧ែࡀ⥆ࡁࠊ ᖺ௨㝆 ྎ࡛᥎⛣ࡋ࡚࠸ࡓࡶࡢࡀࠊ ᖺࡼࡾ෌ࡧቑຍഴྥ࡟࠶ࡿࠋୖグ⛯ไᨵ㠉ἲ᱌ᡂ❧๓ࡢண࡛࠶ࡿࡀࠊ&06࡟ࡼࢀࡤ  ᖺ࡟ࡣᅜẸಖ೺ᨭฟࡀᑐ *'3 ẚ ࡟㏕ࡿ࡜ண᝿ࡉࢀ࡚࠾ࡾࠊ་⒪㈝ࡢไᚚࡣ୍
኱ㄢ㢟࡛࠶ࡿࡇ࡜࡟┦㐪࡞࠸ࠋ ᖺ࡟㉸ඪὴ࡛ᡂ❧ࡋࡓ࣓ࢹ࢕ࢣ࢔࢔ࢡࢭࢫ࣭&+,3 ᨵṇἲ 0$&5$ࡢ᪋⾜ࡀ╔ᐇ࡟㐍ࢇ࡛࠾ࡾࠊఏ⤫ⓗ࡟ )HH)RU6HUYLFH ࡛࠶ࡗࡓ 0HGLFDUH3DUW%㸦་ᖌྥࡅᨭᡶ㸧ࡀ  ✀㢮ࡢ౯್ 9DOXH ࡟ᛂࡌࡓᨭᡶ࠸య⣔࡟௦ࢃࢁ࠺࡜ࡋ࡚࠸ࡿࠋ ᖺࡢࣃࣇ࢛࣮࣐ࣥࢫࢹ࣮ࢱ࡟ᇶ࡙ࡁ  ᖺ࠿ࡽ᪂᪉ᘧࡢᨭᡶ࠸ࡀ㛤ጞࡉࢀࡿணᐃ࡛࠶ࡾࠊ㈝⏝࡜㉁ࢆ࡝࠺ᨵၿࡋ࡚࠸ࡃ࠿ࠊࡑࡢ

8Whitehouse ࢙࢘ࣈࢧ࢖ࢺ
https://www.whitehouse.gov/briefings-statements/building-stronger-america-president-donald-j-trumps-american-infrastructureinitiative/

9㆟఍ண⟬ᒁ(CBO)ሗ࿌᭩ https://www.cbo.gov/publication/53300

10OECD Health at a Glance 2017, p134-135 http://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

11Health Expenditure and Financing, OECD Health Statistics 2017 http://stats.oecd.org/Index.aspx?DataSetCode=SHA

12

Center for Medicare and Medicaid Services https://www.cms.gov/

13CMS 2016-2025 Projections of National Health Expenditures Data Released
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-02-15-2.html ͤOECD
ࡢಖ೺་⒪ᨭฟ(Health Expenditure)࡜⡿ᅜ CMS ࡢᅜẸಖ೺ᨭฟ(National Health Expenditure)ࡣᐃ⩏ࡀ␗࡞ࡾࠊ๓⪅ࡢ᪉ࡀⱝᖸ್ࡣప࠸Ⅽࠊẚ㍑ࡢ㝿࡟ࡣὀពࢆせࡍࡿࠋ14

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ࢭࣥࢧ࣮ࢆᇙ㎸ࢇࡔࢹࢪࢱࣝ〇๣㸦ၟရྡ $ELOLI\0\&LWH㸧ࡀᢎㄆࡉࢀࡓࠋࡇࢀࡽࡣ᪂ࡓ࡞ࢹࣂ࢖
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15

FDA ࣉࣞࢫ࣮ࣜࣜࢫ https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm574058.htm

16

FDA ࣉࣞࢫ࣮ࣜࣜࢫ https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm581216.htm

17

FDA ࣉࣞࢫ࣮ࣜࣜࢫ https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm589467.htm

18

CAR-T ⒪ἲ:37.3,47.5 ୓ࢻࣝ㸦2 ♫ᢎㄆ῭ࠊࡑࢀࡒࢀ㐺⏝⑌ᝈࡣ␗࡞ࡿ㸧ࠊLuxturna®:∦┠࠶ࡓࡾ 42.5 ୓ࢻࣝ

19

FDA ࣉࣞࢫ࣮ࣜࣜࢫ https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm576087.htm

20

FDA ࣉࣞࢫ࣮ࣜࣜࢫ https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm584933.htm

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