愛華網去年的2月27日，一位59歲的硬件銷售員完成了肺癌的最后一期治療后被上海一家醫(yī)院出院。醫(yī)生告訴秦先生的兒子：所有病人住院不能超過2周，而他的父親已經住了差不多三周了。第二天秦先生兒子給上海市委書記YUZS寫了一封抱怨上海醫(yī)療體制的公開信并且在網上發(fā)表。在看來是中國官方回應形式的新象征，上海官方在一天后的新浪微博由俞書記本人予以回復：俞強調秦家在醫(yī)保體系中被一些制度缺陷傷害，我不能保證所有的問題都能很快的解決，但我相信你的心痛也是我們的心痛。第二天，秦老先生逝世。在他生命中最后兩個月里，他被4家不同的醫(yī)院轉院7此。秦先生的遭遇并非特例，媒體經常報道醫(yī)院如何相互推諉重病人的，這也是醫(yī)療體制改革過半的證明。10年前情況更糟，此類情形已經成為定勢，只有很少的公共或是商業(yè)醫(yī)療保險支付醫(yī)療費用。2009年后，意識到這種半市場化醫(yī)療體系所帶來的憤怒，中國政府加速了改革步伐以使得健保體系更實用和能夠承擔。現在超過95%的人口已經被一些公共健康保險覆蓋。2012出版的柳葉刀指出：這個計劃平均支付大約一半患者的住院費用，而患者自行承擔另外一半。
ON FEBRUARY 27th last year QinJinpei, a 59-year-old hardware salesman, was discharged from ahospital in Shanghai where he had been treated for the last stagesof lung cancer. A doctor told Mr Qin’s son, Qin Ling, that nopatient could stay longer than two weeks, and his father had stayedfor almost three. The next day Qin Ling wrote an open letter ofcomplaint to Shanghai’s then Communist Party secretary, YuZhengsheng, which he also posted on the internet. In a sign of thenew “responsiveness” of some parts of Chinese officialdom, theShanghai government posted an answer from Mr Yu a day later on SinaWeibo, a Twitter-like microblogging service. Mr Yu admitted thatthe Qin family had been “hurt by the flaws” in the health-caresystem. “I cannot guarantee that all the problems will be resolvedvery soon,” he said, “But I believe we all feel your pain.” Thenext day, the elder Mr Qin died. He had been turned away seventimes by four different hospitals in the last two months of hislife.
Mr Qin’s ordeal was hardly unique.News media frequently report how hospitals turn away gravely illpatients, the latest evidence of a half-reformed health-caresystem.
理論上這個體系較以前能給重病患者提供更好的服務，但實際上常常不是如此?；加行〔〉幕颊呤轻t(yī)院歡迎的，但對于大病患者，醫(yī)院出于費用控制，常常被驅逐。這是因為賬款收集系統(tǒng)已經確定了醫(yī)院保險治療多少能從政府返還。醫(yī)院擔心如果他們超過了預算，他們就必須選擇要么為超出的額度由醫(yī)院自己買單或者將秦先生這樣的病人趕出院。
In theory the system should offerbetter care than before for patients with serious diseases, but inpractice the opposite is often true. Patients with minor illnessesbenefit, but hospitals, under pressure to control mounting costs,turn away the very ill. This is because of the caps that have beenplaced on how much insured treatment a hospital can claim back fromthe government. Hospitals fear that, if they exceed the caps, theywill have to choose between paying the extra themselves or turfingout patients like Mr Qin.
隨著醫(yī)保覆蓋范圍的廣度和深度加大，政府負擔的醫(yī)療費用也迅速增加，由2001年的16%到2011年的30%。而患者仍然直接承擔其中約1/3的費用，而社保和商業(yè)保險承擔剩余的。在過去10年里，國家總的醫(yī)療費用增加了幾乎5倍，2011年達到2400億元。麥肯錫預計到2020年將增長到10000億元，幾乎是GDP的7%。屆時醫(yī)保系統(tǒng)在增加新的開支時將遇到麻煩。早些時候中國社科院預計到2017年地方的醫(yī)保資金將出現赤字。
As health-care coverage hasbroadened and deepened, so the government’s share of healthspending has ballooned, from 16% in 2001 to 30% in 2011. Patientsstill directly bear more than a third of the total costsnationwide. Social and commercial insurance make up the rest. Overthe past decade the country’s total health expenditure has grownalmost fivefold, to an estimated 2.4 trillion yuan ($385 billion)in 2011. McKinsey, a consulting firm, expects it to reach $1trillion by 2020, roughly 7% of GDP. The health-care system willhave trouble absorbing the added costs. Preliminary estimates bythe Chinese Academy of Social Sciences in Beijing suggest that manylocal state-run health-insurance funds across China will begin torun deficits in 2017.
像美國一樣，不必要和無效的健保成為了中國醫(yī)保體系增加的一部分。醫(yī)院被允許有15%的加價率，顯然是鼓勵工資低的內科醫(yī)師開更貴的處方藥物。這是和收費系統(tǒng)相關的，政府對醫(yī)院的每項服務支付，而不管他的療效，這也使得醫(yī)生去執(zhí)行不必要的檢查和治療。
As in America, inefficient andunnecessary care has contributed to the growing cost of Chinesehealth care. Hospitals are allowed to charge a 15% mark-up on theprice of medicines, which inevitably encourages low-paid physiciansto prescribe more expensive drugs. This is combined with a feesystem, in which hospitals are reimbursed by the government foreach service, regardless of the quality of care, thus givingdoctors an incentive to perform unnecessary tests andtreatments.
A decade ago the situation wasmuch worse and such scenarios would have been the norm, as therewas little health insurance—public or private—to defray the cost ofmedical treatment. The free health care of the Maoist era had, likemuch of China, become geared towards profit in the 1980s and 1990s,leaving most Chinese people to pay for most of their own treatment.After 2009, aware of the anger caused by the failedsemi-marketisation of the system, the Chinese governmentaccelerated reforms to make health care more accessible andaffordable. Now more than 95% of the population is covered by somepublic health insurance. The schemes pay for, on average, abouthalf of in-patients’ costs once they are admitted to hospital,according to a study published in 2012 in the Lancet, amedical journal. The patient must pay for the otherhalf.
醫(yī)生，由你來買單
根據預算規(guī)則，醫(yī)院對于超支部分要承擔40%。二月份北京一位醫(yī)生在網上發(fā)布一條她收到的同事的信息,被要求每位病人的治療費用控制在10500元以下（1700美元）。信息顯示如果超過了這個預算，那么超額部分將從他的工資扣除。類似嚴厲控制費用的措施很普遍。一位來自廣州不愿透露姓名的醫(yī)院管理者說，醫(yī)院對于每個病人的額度是4300元。如果患者兩周內沒有康復，醫(yī)院將盡一切可能讓他們出院。于是出現了患者被一些不需要的檢查和治療過度治療，同時重病患者沒有得到足夠治療。北京大學的GUXIN說衛(wèi)生部當局制定了乏善可陳的游戲規(guī)則，結果毀掉了游戲。
Doc, your paycheque
Underthe budget caps, hospitals are financially liable for up to 40% ofthe excess. In February a Beijing doctor posted online a messageshe received from a colleague, who had been ordered to keep thecost of treatment of each patient under 10,500 yuan ($1,700). Themessage said that if physicians exceeded the budget, the extraexpenses would be deducted from their own salaries. Such harshmeasures to control costs are widespread. A hospital administratorin Guizhou province, who did not want his name used, says that thecost of treating each patient at his hospital is capped at 4,300yuan. If a patient does not recover in two weeks, he says, “Wewould do whatever was necessary to get him out of here.” Sopatients are being both overtreated, with drugs and tests they donot need, and undertreated by not being admitted in the mostserious cases. Gu Xin of Peking University says the healthauthorities “devised poor rules of the game and, as a result, theyruined the game.”
當局強調醫(yī)院禁止驅逐病人，否則他們將剝奪接受醫(yī)保病人的資格。但沒有任何報導顯示醫(yī)院接受過這樣的處罰。政府運營的公立醫(yī)院的顯著壟斷性使得很難被外界監(jiān)督和競爭。盡管政府鼓勵私立醫(yī)院開設，他們僅僅主要面向富人階層。絕大多數的人仍然前往公立醫(yī)院就診。
Local authorities stress thathospitals are prohibited from turning patients away, and they maybe disqualified from receiving patients if they do so, but therehave been no reports of any hospitals being punished in this way.With significant monopoly power, government-run public hospitalsare often shielded from outside inspection and competition, saysZhu Hengpeng of the Chinese Academy of Social Sciences. Though thegovernment is encouraging private hospitals to set up shop, theymainly treat the rich. Most people still go to publichospitals.
然而，嚴重疾病患者繼續(xù)遭受煎熬。秦嶺在父親逝世后，一直在幫助晚期癌癥患者能得到足夠的治療。但他說他在幫助病人獲得足夠治療方面經常會有麻煩。
Meanwhile, the seriously illcontinue to suffer. Since his father’s death, Qin Ling has beentrying to help late-stage cancer patients receive adequate care.But he says he still often has trouble getting the patientsadmitted for treatment.
