2014.04.26【英译汉】What American Healthcare Can Learn From Germany 4

ydyinglluk (Erin) 译坛新秀
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发表于:2014-04-26 09:06 [只看楼主] [划词开启]

Perhaps the biggest difference between our two approaches is the extent to whichGermanyhas managed to rein in the cost of healthcare for consumers. Prices for procedures there are lower and more uniform because doctors’ associations negotiate their fees directly with all of the sickness funds in each state. That's part of the reason why an appendectomy costs $3,093 inGermany, but $13,000 in theU.S.

可能德美两国医疗健康保险的区别在于德国成功的控制了消费者一方在医疗健康保险上的成本。由于德国   医师协会直接和各州的疾病基金会协商他们的费用,因此医疗检查的价格比较低,而且常常是规定的。这也是为什么在德国阑尾切除手术只要花3093美元,而在美国却要花13000美元。

“InGermany, there is a uniform fee schedule for all physicians that work under the social code,” Schlette said. “There’s a huge catalogue where they determine meticulously how much is billed for each procedure. That’s like the Bible.”

“在德国,对于社会保险编号覆盖下的所有医生如何收取的诊疗费用有着明确的规定,”Schlette说,“这份规定细致的规定了大量医师决定的医疗检查程序和相应的费用标准,这感觉就像一本圣经一样。”

In theU.S., meanwhile, a trip to the doctor or hospital is still a roulette of billing discrepancies and not-covered expenses.

同时在美国,医生和医院的收费更像是一场轮盘赌——一大堆账单差异和非覆盖花销使得美国医院的花销更具有不确定性。

Obamacare, meanwhile, has tried to cut healthcare costs primarily by taking aim at the number of unnecessary procedures. Medicare’s payments to hospitals are now partly tied to readmission rates, and last year Medicare punished more than 2,000 hospitals for not doing a better job of keeping patients out of the ER. There have also been 114 Accountable Care Organizations created, but so far only 29 have saved enough money to qualify for bonus payments.

而奥巴马医保在削减医疗保健成本的主要方向,就是免去不必要的检查程序。对于医院的医疗费用现在一部分和再入院率挂钩,在去年,医保法案对两千多家医院采取了惩罚措施,因为他们在治疗急诊患者的方面做的不够。同时,全国建立了144家责任医疗组织,但是直到目前为止只有29家筹集到了标准金额足以支付保险金的款项。

And there are still more cost-cutting measures to come, like taxes on “Cadillac,” or very generous, health plans. Some experts think American customers might become more cost-conscious as they move onto stingier healthcare plans.

接下来还会有更多的削减成本的措施,比如对“凯迪拉克”进行征税,或者是其它慷慨且有益的计划。一些专家认为随着更为“小气”的医疗保险法案的实施,美国的消费者可能变得更节俭。

And certainU.S.states have tried a more German strategy, attempting to keep costs low by setting prices across the board.Maryland, for example, has been regulating how much all of the state’s hospitals can charge since 1977. A 2009study published in Health Affairs found that we would have saved $2 trillion if the entire country’s health costs had grown at the same rate asMaryland’s over the past three decades.

事实上美国也在尝试一种更为德国化的策略,通过全面定价的方式将成本控制在较低水平。比如马里兰州,自从1977年就开始管理全州的医院的收费标准。一项刊登在2009年《卫生保健》杂志上的调查报告前世,如果在过去的三十年里,全国的医疗花费和马里兰州的收费标准持平,大概可以总共省下2千亿美元。

Now,Marylandis going a step further still, having just launched a plan to cap the amount each hospital can spend, total, each year. The state's hospital spending growth will be limited to 3.58 percent for the next five years.

而今,马里兰州正在继续推进改革,最近出台了一项政策即设置每年每所医院花销总额上限。在未来五年内,该州的医院花销增长率将被控制在3.58%左右.

“We know that right now, the more [doctors] do, the more they get paid,” John Colmers, executive director ofMaryland’s Health Services Cost Review Commission, told me. “We want to say, ‘The better you do, the better you get paid.’”

“我们现在知道,医生干的越多,他们拿的钱也越多。”马里兰州健康服务费用审查委员会的执行总裁,约翰·科莫告诉我。“我们想说的是:你干的越好,拿得越多。”

Two other small, left-leaning states, Vermont and Massachusetts, are experimenting with similar measures, but some experts doubt that this sort of top-down thriftiness can be imposed in every state, or even in most states. As we’ve seen from the bitter fight over Medicaid expansion, conservative states tend to balk at government directives.

另外两个左倾的小州,佛蒙特州和马赛诸塞州,也采用了相似的体系,但是一些专家认为这种自上而下的节约型医保并不是什么万灵药,甚至可能对于大部分州而言都不适用。正如之前我们所见,关于医疗保险开支增加的鏖战,政见保守的州可能会对这种政府主导型的体系嗤之以鼻。

“These states are all unabashedly in the new (or rediscovered) category of states who recognize that the authority of government is an essential ingredient to finding a sustainable level of total health spending,” John McDonough, a professor at the Harvard School of Public Health, told me. “The red states are unlikely to follow their lead. The notion that government may be a big part of the solution, instead of the problem, is anathema, and Republican controlled legislatures, and their governors, would find it too substantial a conflict to pursue with any vigor.”

约翰·麦克唐纳,一名哈佛大学公共健康学院的教授这样对我说:“支持将政府权威作为持续支持全面医疗体系开支的必要前提的州都是一群不害臊的家伙,红州(支持共和党的州)不可能接受他们的领导。政府作为解决问题的垫脚石而不是绊脚石的观点简直就是一场噩梦,当共和党人控制了州议院,他们的州长,当他们真正投入精力去做这件事情的时候,他们将会发现这是多么大的一场冲突。“

What’s more, no other state hasMaryland’s uniform, German-style payment system in place, “soMarylandstarts the race nine paces ahead of the other 46 states,” McDonough said.

更有甚者,几乎没有其他州有着马里兰州这样统一的德国模式的医疗费支付系统,“因此马里兰州已经遥遥领先于其他州了。”麦克唐纳说道。

In a 2012 report on the German and American healthcare systems, Göpffarth pointed out that though theU.S.andGermanyare both desperately trying to make healthcare less expensive, the unique spirit of each country is what ultimately gets in its way.Germany’s more orderly system can be too rigid for experimentation. AndAmerica’s free-for-all, where hospitals and doctors all charge different amounts, is great for innovation but too chaotic to make payment reforms stick.

在一份2012年关于美德两国医疗保健体系调查报告中,Göpffarth指出,无论是美国还是德国,他们都在竭力试图削减医疗保健体系的开支,而这两个国家独特的精神内核是两国选择了自己所需要的体制的最终原因。德国程序化的体系可能太过于僵硬以至于失去可操作性。而美式的全民免费,医生和医院的收费天差地别,则有助于创新,但同时也带来太多的混乱局面,最终导致支付体系的改革变得尖锐。

In fact, Göpffarth thinks rising health costs will continue to be the main problem for Americans as we launch into our more Bismarckian system.

事实上,Göpffarth觉得对于美国人来说,随着我们的体系走入“俾斯麦模式”,日益增长的医疗保健支出将继续成为一个主要的问题。

“The main challenge you’ll have is price control,” he said. “You have subsidies in health exchanges now, so for the first time, the federal budget is really involved in health expenditure increases in the commercial market. In order to keep your federal budget under control, you’ll have to control prices.”

“最大的挑战在于价格控制,”他说,“现在你已经可以享有健康保险交易的补贴,所以这也是有史以来首次,在商业化市场中,联邦政府的账单真正和健康保险的花销挂钩起来。如果要使联邦预算能够得以控制,你就得控制价格。”

And though we’ve followed the lead ofGermanyand other European systems to get where we are now, no country has quite figured out that last part yet.

但是尽管我们跟随者德国和其他欧洲国家的步伐建立了当下我们的体系,却仍然没有哪一个国家真正的解决了最后那部分问题。


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2014.04.22【英译汉】What American Healthcare Can Learn From Germany 1

2014.04.26【英译汉】What American Healthcare Can Learn From Germany 2

2014.04.26【英译汉】What American Healthcare Can Learn From Germany 3

2014.04.26【英译汉】What American Healthcare Can Learn From Germany 4



最后编辑于:2014-04-26 09:11
分类: 英语
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