2014年经济学人 越南卫生保健 一路跛行

Health care in Vietnam

Limping along

Ordinary folk are sick and tired of their public hospitals

Full to overflowing¹

WAS the tumour² malignant³? Nguyen Thi Hoat's doctors could not tell because their public hospital lacks brain-scanners. Ms Hoat's only option was to travel 130km (80 miles), on the back of her sister's motorbike, from her village to a crowded public hospital in the capital. Yet her state insurance policy covers just 30% of any medical expenses incurred⁵ outside her home province. The $150 that Ms Hoat, a rice farmer, put towards blood tests and a brain scan is equal, for her, to a month's earnings⁷.

It is the job of the authorities to look after health care. The Communist Party of Vietnam first pledged health-sector⁸ reform as early as the 1920s, well before it declared the country independent in 1945. It developed a publicly financed healthcare system even as it was fighting wars against France and then America. The provision of health care is supposed to be one of the pillars on which the party's legitimacy⁹ is based.

Yet the health-care system, like the state-dominated economy, is limping. The 3% of GDP the state spends on the system (nearly half of total health spending) is not enough to improve health infrastructure¹⁰. Hospitals have outdated¹¹ facilities and maddeningly opaque¹² bureaucracies. A law on health insurance passed in 2008, created to assist the poor and ethnic¹³ minorities, is far from comprehensive. But the government knows that providing proper health care is key to preventing the kind of social unrest that undermines its authority.

Some reform is under way. The government has given some hospitals more autonomy. And in June the national assembly passed a new version of the insurance law designed to make participation¹⁴ compulsory¹⁵. The idea is to lure¹⁶ into the fold poorer and black-market workers who have long avoided paying insurance.

Yet distrust of the system runs deep. Some public hospitals have built flashy new wings which cater¹⁷ to well-heeled patients but do little to meet general demand. Bed-sharing is common, especially in urban wards⁶ flooded by patients from the countryside.

Though this is an authoritarian¹⁸ state, ordinary Vietnamese are remarkably¹⁹ outspoken²⁰ about social issues. In health, they complain of the prevalence of “out of pocket” payments, which happen in around half of health-care transactions. Many of the payments are really bribes²¹ paid on top of formal hospital fees. They mean that affordability²² is often a larger factor than need, for all but the richest patients. In a typical case, a university lecturer in Hanoi says she slipped doctors and nurses about $250 to ensure attentive²³ treatment when she gave birth at a public maternity²⁴ hospital. The rate, she says, was $1 per injection, $2 for a bath and $5 to sidestep a queue.

The health minister, Nguyen Thi Kim Tien, has faced blistering²⁵ criticism this year after a parade of health scandals, including a measles²⁶ outbreak that killed more than 100 children. Online, thousands have called for her resignation. A popular television satire²⁷ advises sick patients to avoid corrupt²⁸ doctors by curing themselves. The fault is not all the minister's—or the doctors'; they have long earned as little as $100 a month, for instance.

In order to get by, doctors moonlight at private hospitals and clinics that are popping up in cities, led by Hanoi and Ho Chi Minh City, to serve foreigners and affluent²⁹ Vietnamese, people who would otherwise opt⁴ for treatment in Singapore or Hong Kong. One such institution is Vinmec International Hospital, a 600-bed facility financed by Vingroup, a property developer. Its director, Nguyen Thanh Liem, says private hospitals help to minimise overcrowding elsewhere. And they showcase an international standard of care that may one day spread to the public sector.

That is cold comfort for Nguyen Thi Hoat, the rice farmer with a brain tumour. She says if her tumour proves cancerous, she will need to borrow from her brother and sister for surgery in Hanoi. Her family is worried. Yet poorer neighbours, she says, have fewer options. She considers herself lucky.

1 overflowing   

n. 溢出物,溢流 adj. 充沛的，充满的 动词overflow的现在分词形式

参考例句：

• The stands were overflowing with farm and sideline products. 集市上农副产品非常丰富。
• The milk is overflowing. 牛奶溢出来了。

2 tumour   

n.(tumor)(肿)瘤，肿块

参考例句：

• The surgeons operated on her for a tumour.外科医生为她施行了肿瘤切除手术。
• The tumour constricts the nerves.肿瘤压迫神经。

3 malignant   

adj.恶性的，致命的；恶意的，恶毒的

参考例句：

• Alexander got a malignant slander.亚历山大受到恶意的诽谤。
• He started to his feet with a malignant glance at Winston.他爬了起来，不高兴地看了温斯顿一眼。

4 opt   

vi.选择，决定做某事

参考例句：

• They opt for more holiday instead of more pay.他们选择了延长假期而不是增加工资。
• Will individual schools be given the right to opt out of the local school authority?各个学校可能有权选择退出地方教育局吗？

5 incurred   

[医]招致的，遭受的； incur的过去式

参考例句：

• She had incurred the wrath of her father by marrying without his consent 她未经父亲同意就结婚，使父亲震怒。
• We will reimburse any expenses incurred. 我们将付还所有相关费用。

6 wards   

区( ward的名词复数 )； 病房； 受监护的未成年者； 被人照顾或控制的状态

参考例句：

• This hospital has 20 medical [surgical] wards. 这所医院有 20 个内科[外科]病房。
• It was a big constituency divided into three wards. 这是一个大选区，下设三个分区。

7 earnings   

n.工资收人；利润，利益，所得

参考例句：

• That old man lives on the earnings of his daughter.那个老人靠他女儿的收入维持生活。
• Last year there was a 20% decrease in his earnings.去年他的收入减少了20%。

8 sector   

n.部门，部分；防御地段，防区；扇形

参考例句：

• The export sector will aid the economic recovery. 出口产业将促进经济复苏。
• The enemy have attacked the British sector.敌人已进攻英国防区。

9 legitimacy   

n.合法，正当

参考例句：

• The newspaper was directly challenging the government's legitimacy.报纸直接质疑政府的合法性。
• Managing from the top down,we operate with full legitimacy.我们进行由上而下的管理有充分的合法性。

10 infrastructure   

n.下部构造，下部组织，基础结构，基础设施

参考例句：

• We should step up the development of infrastructure for research.加强科学基础设施建设。
• We should strengthen cultural infrastructure and boost various types of popular culture.加强文化基础设施建设，发展各类群众文化。

11 outdated   

adj.旧式的，落伍的，过时的；v.使过时

参考例句：

• That list of addresses is outdated,many have changed.那个通讯录已经没用了，许多地址已经改了。
• Many of us conform to the outdated customs laid down by our forebears.我们许多人都遵循祖先立下的过时习俗。

12 opaque   

adj.不透光的；不反光的，不传导的；晦涩的

参考例句：

• The windows are of opaque glass.这些窗户装着不透明玻璃。
• Their intentions remained opaque.他们的意图仍然令人费解。

13 ethnic   

adj.人种的，种族的，异教徒的

参考例句：

• This music would sound more ethnic if you played it in steel drums.如果你用钢鼓演奏，这首乐曲将更具民族特色。
• The plan is likely only to aggravate ethnic frictions.这一方案很有可能只会加剧种族冲突。

14 participation   

n.参与，参加，分享

参考例句：

• Some of the magic tricks called for audience participation.有些魔术要求有观众的参与。
• The scheme aims to encourage increased participation in sporting activities.这个方案旨在鼓励大众更多地参与体育活动。

15 compulsory   

n.强制的，必修的；规定的，义务的

参考例句：

• Is English a compulsory subject?英语是必修课吗？
• Compulsory schooling ends at sixteen.义务教育至16岁为止。

16 lure   

n.吸引人的东西，诱惑物；vt.引诱，吸引

参考例句：

• Life in big cities is a lure for many country boys.大城市的生活吸引着许多乡下小伙子。
• He couldn't resist the lure of money.他不能抵制金钱的诱惑。

17 cater   

vi.(for/to)满足，迎合；(for)提供饮食及服务

参考例句：

• I expect he will be able to cater for your particular needs.我预计他能满足你的特殊需要。
• Most schools cater for children of different abilities.大多数学校能够满足具有不同天资的儿童的需要。

18 authoritarian   

n./adj.专制(的)，专制主义者，独裁主义者

参考例句：

• Foreign diplomats suspect him of authoritarian tendencies.各国外交官怀疑他有着独裁主义倾向。
• The authoritarian policy wasn't proved to be a success.独裁主义的政策证明并不成功。

19 remarkably   

ad.不同寻常地，相当地

参考例句：

• I thought she was remarkably restrained in the circumstances. 我认为她在那种情况下非常克制。
• He made a remarkably swift recovery. 他康复得相当快。

20 outspoken   

adj.直言无讳的，坦率的，坦白无隐的

参考例句：

• He was outspoken in his criticism.他在批评中直言不讳。
• She is an outspoken critic of the school system in this city.她是这座城市里学校制度的坦率的批评者。

21 bribes   

n.贿赂( bribe的名词复数 )；向（某人）行贿，贿赂v.贿赂( bribe的第三人称单数 )；向（某人）行贿，贿赂

参考例句：

• It was alleged that he had taken bribes while in office. 他被指称在任时收受贿赂。
• corrupt officials accepting bribes 接受贿赂的贪官污吏

22 affordability   

可购性

参考例句：

• Performance-Based Logistics Affordability: Can We Afford Categorical Conversion to Performance-Based Acquisition? 基于性能的后期的可承受性：能否担负得起向基于性能的采办的无条件的转变？
• There would be no crisis of affordability, as't for food or clothing. 就想食物与服装一样，因为供给没有危机。

23 attentive   

adj.注意的，专心的；关心(别人)的，殷勤的

参考例句：

• She was very attentive to her guests.她对客人招待得十分周到。
• The speaker likes to have an attentive audience.演讲者喜欢注意力集中的听众。

24 maternity   

n.母性，母道，妇产科病房；adj.孕妇的，母性的

参考例句：

• Women workers are entitled to maternity leave with full pay.女工产假期间工资照发。
• Trainee nurses have to work for some weeks in maternity.受训的护士必须在产科病房工作数周。

25 blistering   

adj.酷热的；猛烈的；使起疱的；可恶的v.起水疱；起气泡；使受暴晒n.[涂料] 起泡

参考例句：

• The runners set off at a blistering pace. 赛跑运动员如脱缰野马般起跑了。
• This failure is known as preferential wetting and is responsible for blistering. 这种故障称为优先吸湿，是产生气泡的原因。 来自辞典例句

26 measles   

n.麻疹，风疹，包虫病，痧子

参考例句：

• The doctor is quite definite about Tom having measles.医生十分肯定汤姆得了麻疹。
• The doctor told her to watch out for symptoms of measles.医生叫她注意麻疹出现的症状。

27 satire   

n.讽刺，讽刺文学，讽刺作品

参考例句：

• The movie is a clever satire on the advertising industry.那部影片是关于广告业的一部巧妙的讽刺作品。
• Satire is often a form of protest against injustice.讽刺往往是一种对不公正的抗议形式。

28 corrupt   

v.贿赂，收买；adj.腐败的，贪污的

参考例句：

• The newspaper alleged the mayor's corrupt practices.那家报纸断言市长有舞弊行为。
• This judge is corrupt.这个法官贪污。

29 affluent   

adj.富裕的，富有的，丰富的，富饶的

参考例句：

• He hails from an affluent background.他出身于一个富有的家庭。
• His parents were very affluent.他的父母很富裕。