前日,，新聞機(jī)構(gòu)Kaiser Health News就利潤(rùn)豐厚的驗(yàn)?zāi)蛏獍l(fā)表了一篇有趣的調(diào)查報(bào)告,，作者是弗雷德·舒爾特和伊麗莎白·盧卡斯（對(duì),，這是真的）,。在梅奧醫(yī)學(xué)中心研究人員的幫助下，這個(gè)團(tuán)隊(duì)仔細(xì)研究了美國(guó)聯(lián)邦醫(yī)療保險(xiǎn)和私營(yíng)保險(xiǎn)公司的計(jì)費(fèi)數(shù)據(jù),，他們 “發(fā)現(xiàn)2011-2014年間,，花在尿液檢查和相關(guān)基因檢測(cè)上的錢(qián)增加了三倍，估算年支出額為85億美元,，超過(guò)了美國(guó)環(huán)保署的全部預(yù)算”,。兩位作者還發(fā)現(xiàn)，2014年聯(lián)邦政府基于尿液的濫用藥物檢測(cè)支出實(shí)際上超過(guò)了“最受推崇的四種癌癥篩查總開(kāi)支”,。

其動(dòng)力在很大程度上源于泛濫全美的阿片類(lèi)藥物,。由于醫(yī)生開(kāi)給病人的止痛藥數(shù)量呈不斷增長(zhǎng)態(tài)勢(shì),，醫(yī)療管理機(jī)構(gòu)、州監(jiān)管部門(mén)和保險(xiǎn)公司都在尋找追蹤病人用藥情況的途徑,。同時(shí),，開(kāi)處方藥的醫(yī)生也希望將自己的潛在責(zé)任控制在一定限度內(nèi)，同時(shí)充分履行監(jiān)督病人的職責(zé),，以滿足資質(zhì)認(rèn)證機(jī)構(gòu)的要求,。胸懷大志的創(chuàng)業(yè)者自然而然地開(kāi)始著手滿足這些需求，進(jìn)而把許多疼痛管理醫(yī)療機(jī)構(gòu)變成了藥檢中心,。

當(dāng)然,，一部分檢測(cè)從醫(yī)療角度而言是恰當(dāng)?shù)模皇沁€不清楚此類(lèi)檢測(cè)有多少,。去年,，美國(guó)疾病控制與預(yù)防中心建議病人在剛開(kāi)始接受阿片類(lèi)藥物治療時(shí)進(jìn)行檢驗(yàn)，長(zhǎng)期使用者則進(jìn)行年檢,，但該中心將是否進(jìn)一步進(jìn)行檢測(cè)的決定權(quán)留給了醫(yī)生,。

舒爾特和盧卡斯指出，這項(xiàng)決定權(quán)似乎成了一些疼痛治療機(jī)構(gòu)的生財(cái)之道,。他們?cè)趫?bào)告中指出：“2014和2015年,，聯(lián)邦醫(yī)保為藥物相關(guān)檢測(cè)支付了100萬(wàn)美元，甚至更多,，開(kāi)出檢驗(yàn)單的是美國(guó)各地50多個(gè)疼痛管理機(jī)構(gòu)的醫(yī)療保健專(zhuān)業(yè)人士,。”這個(gè)團(tuán)隊(duì)還發(fā)現(xiàn),，31位醫(yī)生“80%甚至以上的聯(lián)邦醫(yī)保收入完全來(lái)自驗(yàn)?zāi)??！遍喿x報(bào)告的聯(lián)邦官員稱(chēng)這個(gè)發(fā)現(xiàn)“令人不安”,。

舒爾特和盧卡斯說(shuō)，去年聯(lián)邦醫(yī)保加強(qiáng)了對(duì)尿液檢測(cè)的監(jiān)督,，并下調(diào)了針對(duì)檢驗(yàn)機(jī)構(gòu)的報(bào)銷(xiāo)比例,。但就算這樣，仍有許多人繼續(xù)開(kāi)采這個(gè)“液體金礦”,。（財(cái)富中文網(wǎng)）

譯者：Charlie?

Kaiser Health News published a fascinating investigation by Fred Schulte and Elizabeth Lucas into the lucrative realm of urine testing yesterday. (Yes, really.) The team sifted through reams of billing data from Medicare and private insurers with the help of researchers at the Mayo Clinic and “found that spending on urine screens and related genetic tests quadrupled from 2011 to 2014 to an estimated $8.5 billion a year—more than the entire budget of the Environmental Protection Agency.” In the last of those years, the reporters discovered, the federal government actually spent more on urine-based drug tests than it did on “the four most recommended cancer screenings combined.”

Much of this has been driven by the national opioid epidemic. As doctors began prescribing an ever-growing number of pain pills, medical boards, state regulators, and insurers sought a way to track the medicines in patients. Prescribers, meanwhile, also hoped to limit their own potential liability and satisfy licensing boards that they were doing their due diligence in monitoring patients. Naturally, ambitious entrepreneurs set out to meet these needs—transforming many pain management clinics into drug-testing facilities.

Some of this testing, to be sure, is medically appropriate—though it’s not clear how much. Last year, the CDC recommended that patients be tested when they begin opioid therapy and that long-term users be checked annually, though it left further testing decisions to the discretion of the health practitioner.

That discretion, it seems, has led to a financial boon for some pain clinics, Schulte and Lucas say. “In 2014 and 2015, Medicare paid $1 million or more for drug-related tests billed by health professionals at more than 50 pain management practices across the U.S.,” they report. The team also found 31 practitioners who “received 80 percent or more of their Medicare income just from urine testing”—a fact that federal officials who reviewed the findings called “troubling.”

Last year, Medicare imposed tougher scrutiny on urine testing and cut its reimbursement levels to providers, say Schulte and Lucas. But even so, many have continued to mine for this “l(fā)iquid gold.”