过去三个月，美国国家卫生研究所已经历了包括病人护理及医药费保障支出等事项的变迁调整。

The transition to an institute was included in the Patient Protection and Affordable Care Act, passed last March.

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南通市自费人群卫生资源利用较低，而淄博市自费人群的经济负担最重，年人均医药费用支出占收入的比例达11.8% ；

The people without health scheme use less health service resource in Nantong. However, they have the heaviest economic burden in Zibo, self paid health expense accounting for 11.8% of annual income.

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此外，以上三种行为均会导致更高的医药费用支出。

Moreover, all three habits lead to higher medical costs.

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