摘要：The US health system spends far more on the “technology” of care (e.g., drugs, devices) than on achieving equity in its delivery. For 1991 to 2000, we contrasted the number of lives saved by medical advances with the number of deaths attributable to excess mortality among African Americans. Medical advances averted 176 633 deaths, but equalizing the mortality rates of Whites and African Americans would have averted 886202 deaths. Achieving equity may do more for health than perfecting the technology of care. Much of the billions of dollars 1 spent in the United States to improve health outcomes is directed at the “technology” of care—the race among private industries and academia to develop better drugs, devices, and procedures. Far less money and infrastructure is devoted to improving health by enhancing equity —achieving equal care for equal need—and eliminating disparities in the treatment and outcomes of those with similar conditions. 2 Whether this asymmetry is prudent is best determined by comparing the degree to which the population benefits from each endeavor. Does society save more lives by enhancing the technology of care or by resolving disparities? The answer would take years to determine (data and statistical methods for sound projections are lacking), but today’s policymakers need some guidance, albeit approximate, to judge whether the current balance of effort is best for the population. We performed a “thought experiment” 3 to compare the number of lives saved through the 2 strategies.
