IMF-美国医疗保健：市场力量上升、进入壁垒和供应限制的故事（英）-2021.7.docxVIP

WP/21/180 U.S. Healthcare: A Story of Rising Market Power, Barriers to Entry, and Supply Constraints by Li Lin, Mico Mrkaic and Anke Weber ? 2021 International Monetary Fund WP/21/180 IMF Working Paper Western Hemisphere Department U.S. Healthcare: A Story of Rising Market Power, Barriers to Entry, and Supply Constraints Prepared by Li Lin, Mico Mrkaic and Anke Weber 1 IMF Working Papers describe research in progress by the author(s) and are published to elicit comments and to encourage debate. The views expressed in IMF Working Papers are those of the author(s) and do not necessarily represent the views of the IMF, its Executive Board, or IMF management.Authorized for distribution by Nigel IMF Working Papers describe research in progress by the author(s) and are published to elicit comments and to encourage debate. The views expressed in IMF Working Papers are those of the author(s) and do not necessarily represent the views of the IMF, its Executive Board, or IMF management. Abstract Healthcare in the United States is the most expensive in the world, with real per capita spending growth averaging 4 percent since 1980. This paper examines the role of market power of U.S. healthcare providers and pharmaceutical companies. It finds that markups (the ability to charge prices above marginal costs) for publicly listed firms in the U.S. healthcare sector have almost doubled since the early 1980s and that they explain up to a quarter of average annual real per capita healthcare spending growth. The paper also finds evidence that the Affordable Care Act and Medicaid expansion were successful in raising coverage and expanding care, but may have had the undesirable side-effect of leading to labor cost increases: Hourly wages for healthcare practitioners are estimated to have increased by 2 to 3 percent more in Medicaid expansion states over a five-year period, which could be an indication that the supply of medical services is relatively inelastic, even over a long time ho