前日，新聞機構Kaiser Health News就利潤豐厚的驗尿生意發表了一篇有趣的調查報告，作者是弗雷德·舒爾特和伊麗莎白·盧卡斯（對，這是真的）。在梅奧醫學中心研究人員的幫助下，這個團隊仔細研究了美國聯邦醫療保險和私營保險公司的計費數據，他們 “發現2011-2014年間，花在尿液檢查和相關基因檢測上的錢增加了三倍，估算年支出額為85億美元，超過了美國環保署的全部預算”。兩位作者還發現，2014年聯邦政府基于尿液的濫用藥物檢測支出實際上超過了“最受推崇的四種癌癥篩查總開支”。

其動力在很大程度上源于泛濫全美的阿片類藥物。由于醫生開給病人的止痛藥數量呈不斷增長態勢，醫療管理機構、州監管部門和保險公司都在尋找追蹤病人用藥情況的途徑。同時，開處方藥的醫生也希望將自己的潛在責任控制在一定限度內，同時充分履行監督病人的職責，以滿足資質認證機構的要求。胸懷大志的創業者自然而然地開始著手滿足這些需求，進而把許多疼痛管理醫療機構變成了藥檢中心。

當然，一部分檢測從醫療角度而言是恰當的，只是還不清楚此類檢測有多少。去年，美國疾病控制與預防中心建議病人在剛開始接受阿片類藥物治療時進行檢驗，長期使用者則進行年檢，但該中心將是否進一步進行檢測的決定權留給了醫生。

舒爾特和盧卡斯指出，這項決定權似乎成了一些疼痛治療機構的生財之道。他們在報告中指出：“2014和2015年，聯邦醫保為藥物相關檢測支付了100萬美元，甚至更多，開出檢驗單的是美國各地50多個疼痛管理機構的醫療保健專業人士。”這個團隊還發現，31位醫生“80%甚至以上的聯邦醫保收入完全來自驗尿?！遍喿x報告的聯邦官員稱這個發現“令人不安”。

舒爾特和盧卡斯說，去年聯邦醫保加強了對尿液檢測的監督，并下調了針對檢驗機構的報銷比例。但就算這樣，仍有許多人繼續開采這個“液體金礦”。（財富中文網）

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 “liquid gold.”