当自闭症变成一门大生意:美国千亿医疗市场爆火背后 | 经济学人双语学习笔记 | Autism

文章选自The Economist | Apr 1st 2026.

美国自闭症确诊量 20 年翻四倍，轻症诊断大幅增加，ABA/应用行为分析治疗因医保覆盖需求暴增，吸引私募资本涌入。但行业存在过度治疗、欺诈、预算承压、治疗质量参差不齐等问题，且专业人员流失严重。虽有综合协同治疗模式，却难以普及，整个体系漏洞突出。

标题部分

Demand for autism care is soaring. The system is struggling to cope

A surge in diagnoses has created a booming industry, riddled with incentives that drive up costs and distort care

自闭症护理需求急剧攀升，现有体系已难以应对。

确诊人数激增催生了蓬勃发展的产业，却充斥着各类逐利动机，不断推高成本并扭曲治疗本身。

• soar /sɔː(r)/v. 激增，猛增

• cope /kəʊp/v. 应对，处理

• booming /ˈbuːmɪŋ/adj. 繁荣的，迅猛发展的

• riddled with /ˈrɪdld wɪð/ 充满，充斥 

• distort /dɪˈstɔːt/v. 扭曲，使变形 

正文部分

AUTISM IS A spectrum disorder, meaning people with it have a wide range of traits, strengths and support needs. That diversity is on display at the Cortica therapy centre in Burlington, Massachusetts, where a group of toddlers work their way through an obstacle course. One girl completes it carefully, head down, avoiding eye contact. Another darts into a corner, squeezing her eyes shut, pressing her fingers into her ears and shaking her head. Elsewhere, a boy screams.

自闭症是一种谱系障碍，患者在特征、优势和支持需求上差异极大。这种多样性在马萨诸塞州伯灵顿的 Cortica 治疗中心可见一斑：一群幼儿正在闯障碍关卡。一个女孩低头认真完成，回避眼神交流；另一个猛地冲到角落，紧闭双眼、手指堵耳、不停摇头；还有个男孩在尖叫。

• spectrum disorder /ˈspektrəm dɪsˈɔːdə(r)/n. 谱系障碍 Autism is a typical neurodevelopmental spectrum disorder. 自闭症是典型的神经发育谱系障碍。

• toddler /ˈtɒdlə(r)/n. 学步儿童，幼童 The center provides treatment for toddlers with autism. 该中心为自闭症幼童提供治疗。

• obstacle course /ˈɒbstəkl kɔːs/n. 障碍训练课程 Obstacle courses help improve children’s motor skills. 障碍课程有助于提升儿童运动能力。

• dart /dɑːt/v. 猛冲，飞奔 The child darted away from the group. 孩子突然从人群中跑开。

Roughly 3.2% of American children are on the autism spectrum. In severe cases a person may be unable to speak or dress themselves. Those with milder forms might struggle to communicate or regulate their emotions, but often attend ordinary schools. Autistic children are also more likely to have gastrointestinal problems, obesity, sleep disorders and seizures.

美国约 3.2% 的儿童患有自闭症谱系障碍。重症患者可能无法说话或自理穿衣；轻症患者虽在沟通、情绪管理上存在困难，但通常可就读普通学校。自闭症儿童也更易出现肠胃问题、肥胖、睡眠障碍和癫痫发作。

• regulate /ˈreɡjuleɪt/v. 调节，控制 It is hard for autistic kids to regulate their emotions. 自闭症儿童难以控制自身情绪。

• gastrointestinal /ˌɡæstrəʊɪnˈtestɪnl/adj. 胃肠的 Gastrointestinal problems are common in autistic patients. 肠胃问题在自闭症患者中很常见。

• seizure /ˈsiːʒə(r)/n. 癫痫发作 Seizures may occur in some severe autism cases. 部分重症自闭症患者会出现癫痫发作。

One upshot is that autism care has become a multi-billion-dollar business in America. Demand for treatment has surged, attracting private-equity (PE) firms to the sector (Cortica is backed by a roster of venture-capital and corporate health-care investors). But the system is deeply flawed, with incentives that push up costs. State budgets are strainingunder the burden. And autistic children may not be getting the care they need.

结果之一是，自闭症护理在美国已成为数十亿美元的产业。治疗需求激增，吸引私募股权机构涌入（Cortica 获得多家风投与医疗企业投资）。但该体系存在严重缺陷，激励机制推高成本，各州财政不堪重负，而自闭症儿童未必能获得所需治疗。

• upshot /ˈʌpʃɒt/n. 结果，结局 The upshot is a booming autism care market. 结果是自闭症护理市场蓬勃发展。

• surge /sɜːdʒ/v. 激增，猛增 Demand for therapy has surged in recent years. 近年来治疗需求大幅增长。

• private-equity /ˌpraɪvɪt ˈekwəti/n. 私募股权 PE firms invest heavily in medical services. 私募机构大举投资医疗服务。

• roster /ˈrɒstə(r)/n. 名单，一批 A roster of investors funded the project. 一批投资者为该项目提供了资金。

• flawed /flɔːd/adj. 有缺陷的，存在漏洞的 The current medical system is deeply flawed. 现有医疗体系存在严重缺陷。

• strain /streɪn/v. 使不堪重负，紧张 Government budgets are straining from health costs. 医疗成本让政府预算承压。

These are growing problems in a country where autism diagnoses have quadrupled over the past 20 years. That rise is partly down to improved screening. But the definition has also broadened. Last year an analysis by epidemiologists at the University of Wisconsin found that, between 2000 and 2016, the number of autism diagnoses among children with mild, minimal or no adaptive impairments rose markedly, while moderate to severe cases remained mostly flat.

过去 20 年美国自闭症确诊数量翻了两番，问题愈发突出。增长部分源于筛查技术提升，同时诊断范围也在扩大。威斯康星大学流行病学家发现，2000 至 2016 年，轻度、几乎无适应障碍儿童的确诊数显著上升，中重度病例基本持平。

• quadruple /ˈkwɒdrupl/v. 成为四倍，翻两番 Diagnoses have quadrupled in two decades. 确诊数量二十年间翻了两番。

• broaden /ˈbrɔːdn/v. 扩大，拓宽 The definition of autism has broadened over time. 自闭症的定义范围逐渐扩大。

• epidemiologist /ˌepɪˌdiːmiˈɒlədʒɪst/n. 流行病学家 Epidemiologists study the spread of diseases. 流行病学家研究疾病传播规律。

• impairment /ɪmˈpeəmənt/n. 损伤，障碍 Some patients have only minor cognitive impairments. 部分患者仅存在轻微认知障碍。

One explanation is that an autism diagnosis unlocks care—and insurance coverage—for other conditions. “If your kid has social anxiety, that can look a lot like autism, but it’s really hard to get services to address that,” says David Mandell of the Children’s Hospital of Philadelphia. The Wisconsin study, he says, “shows, in part, the willingness of clinicians to give the diagnosis, and of parents to seek it out”.

一种解释是，自闭症确诊能为其他病症开通治疗与保险通道。费城儿童医院的戴维・曼德尔表示：“孩子若有社交焦虑，症状很像自闭症，但很难获得相应服务。” 他称，威斯康星的研究一定程度上反映出医生愿意开具诊断、家长也主动寻求确诊。

• unlock /ˌʌnˈlɒk/v. 开启，获得 A diagnosis can unlock insurance benefits. 确诊可获得保险赔付。

• clinician /klɪˈnɪʃn/n. 临床医生 Clinicians play a key role in autism diagnosis. 临床医生在自闭症诊断中至关重要。

• seek out /siːk aʊt/v. 主动寻求，寻找 Many parents seek out professional diagnosis. 许多家长主动寻求专业诊断。

Once diagnosed, many children receive Applied Behaviour Analysis (ABA), which relies on reinforcement to encourage desirable behaviours and reduce disruptive ones. Early forms using shocks, restraints or unpleasant tastes or smells have been discarded. ABA’s popularity is in part the result of a sweeping shift in policy. In 2014 federal regulators clarified that Medicaid, the government health programme for the poor, must cover treatment for autistic children.

确诊后，许多儿童会接受应用行为分析（ABA）治疗，通过强化机制鼓励正向行为、减少破坏性行为。早期使用电击、约束或厌恶刺激的方式已被摒弃。ABA 普及一定程度上源于政策重大转变：2014 年联邦明确，面向低收入群体的医疗补助计划必须覆盖自闭症治疗。

• ABA /ˌeɪ biːˈeɪ/n. 应用行为分析 ABA is the most common autism therapy. ABA 是最常见的自闭症治疗方法。

• reinforcement /ˌriːɪnˈfɔːsmənt/n. 强化，奖励 Positive reinforcement shapes children’s behaviour. 正向强化塑造儿童行为。

• disruptive /dɪsˈrʌptɪv/adj. 捣乱的，破坏性的 Disruptive behaviours are common in autistic kids. 破坏性行为在自闭症儿童中较为常见。

• discard /dɪˈskɑːd/v. 抛弃，摒弃 Harmful treatment methods have been discarded. 有害治疗方式已被摒弃。

• sweeping /ˈswiːpɪŋ/adj. 彻底的，全面的 The policy brought a sweeping change to care. 该政策给治疗带来全面变革。

• Medicaid /ˈmedɪkeɪd/n. （美国）医疗补助计划 Medicaid covers many low-income patients. 医疗补助覆盖众多低收入患者。

The effect on budgets has varied, but the overall picture is troubling. In North Carolina, the therapy is on pace to become one of the state’s largest expenditures, with costs rising sharply. In Nebraska, sky-high reimbursement rates made ABA a lucrative market for providers. Visits and spending soared in a few years, forcing the state to lower its rates.

这对各地预算影响不同，但整体形势令人担忧。在北卡罗来纳州，ABA 治疗即将成为该州最大支出项之一，成本急剧攀升。在内布拉斯加州，高额报销比例让 ABA 成为服务商的暴利市场，就诊量与支出几年内暴涨，迫使州政府下调报销标准。

• troubling /ˈtrʌblɪŋ/adj. 令人担忧的 The rising costs are deeply troubling. 成本上涨令人十分担忧。

• expenditure /ɪkˈspendɪtʃə(r)/n. 开支，支出 Health expenditure has increased rapidly. 医疗支出快速增长。

• reimbursement /ˌriːɪmˈbɜːsmənt/n. 报销，补偿 Insurance reimbursement supports therapy costs. 保险报销承担治疗费用。

• lucrative /ˈluːkrətɪv/adj. 获利多的，暴利的 The market became highly lucrative for providers. 该市场对服务商而言利润丰厚。

• soar /sɔː(r)/v. 急剧上升 Medical costs soared in a short time. 医疗成本短期内大幅飙升。

Fraud is a concern. In December 2024 the Department of Health and Human Services began releasing audits of state Medicaid spending on ABA. Four have been published so far; all found improper or potentially improper payments. The most recent report noted problems from uncredentialled therapists to billings for ineligible children, with hundreds of millions in questionable payments.

欺诈问题令人警惕。2024 年 12 月，美国卫生与公众服务部开始审计各州 ABA 医疗补助支出，已发布的四份报告均发现不当或疑似不当支付。最新报告显示，存在治疗师无资质、向不符合条件儿童收费等问题，涉及数亿美元可疑支出。

• fraud /frɔːd/n. 欺诈，骗局 Insurance fraud has increased in medical services. 医疗服务领域保险欺诈增多。

But the system also allows money to be wasted in perfectly legal ways. ABA is often paid per hour, creating incentives for over-treatment. Because the recent surge in diagnoses has been driven by milder cases, the average child should have received fewer hours of care. But data show the share of children getting heavy treatment has increased sharply across the country.

但该体系下，资金也能以完全合法的方式被浪费。ABA 通常按小时计费，催生过度治疗动机。近年确诊激增主要来自轻症，理论上儿童平均治疗时长应减少，但数据显示，全国接受高强度治疗的儿童比例大幅上升。

• over-treatment /ˌəʊvəˈtriːtmənt/n. 过度治疗 Per-hour billing leads to over-treatment. 按小时计费导致过度治疗。

A growing market, predictable funding and fragmentation have attracted PE firms. Between 2017 and 2022 they accounted for 85% of all mergers and acquisitions in the sector. This has raised concerns that profitability may be put ahead of patients’ needs. In some states, PE-backed centres drove much of the rise in billable hours.

市场扩张、资金稳定、行业分散吸引了私募机构。2017 至 2022 年，它们占据该行业 85% 的并购交易，引发盈利优先于患者需求的担忧。在部分州，私募支持的治疗中心是计费时长增长的主要推手。

• fragmentation /ˌfræɡmenˈteɪʃn/n. 分散，碎片化 The industry is marked by fragmentation. 该行业呈现高度分散特点。

• profitability /ˌprɒfɪtəˈbɪləti/n. 盈利能力 Companies prioritize profitability over care quality. 企业将盈利置于治疗质量之上。

Despite all the money flowing into autism services, the quality of care is uneven. Studies show that in controlled settings ABA can help children speak and socialise. But more hours are not necessarily better, and quality depends on therapists’ skills. Increasing reliance on lightly trained staff, low pay and high turnover disrupt treatment, especially for autistic children who need routine.

尽管大量资金涌入自闭症服务领域，治疗质量却参差不齐。研究显示，在受控环境下 ABA 可帮助儿童提升语言与社交能力，但时长并非越多越好，效果取决于治疗师水平。越来越多依赖低资质人员、薪资低、流失率高，对需要规律作息的自闭症儿童冲击尤大。

• uneven /ʌnˈiːvn/adj. 不均衡的，参差不齐的 Service quality is uneven across centres. 各治疗中心服务质量差异巨大。

• turnover /ˈtɜːnəʊvə(r)/n. 人员流失率 High turnover affects treatment continuity. 高流失率影响治疗连续性。

• routine /ruːˈtiːn/n. 常规，惯例 Autistic children rely on daily routines. 自闭症儿童依赖固定日常作息。

Another problem is that, because autism is heterogeneous, children often need different types of care. At the Cortica centre children move between rooms for speech, occupational and paediatric care. Such co-ordinated care is essential. It is also all too rare.

另一问题是，自闭症具有高度异质性，儿童往往需要多种治疗。在 Cortica 中心，孩子会在不同房间接受语言、作业治疗和儿科护理。这种协同治疗至关重要，却极为稀缺。

• heterogeneous /ˌhetərəˈdʒiːniəs/adj. 异质性的，多样的 Autism is a highly heterogeneous disorder. 自闭症是高度异质性障碍。

• co-ordinated /kəʊˈɔːdɪneɪtɪd/adj. 协同的，统筹的 Co-ordinated care improves treatment outcomes. 协同治疗提升康复效果。