2015年经济学人 国民健康保险制度 遇冷的医改

The NHS

Health reform in a cold climate

The government's reforms to the NHS are viewed as its biggest failure. They are better than that

“WITH the Conservatives there will be no more of the tiresome¹,

meddlesome², top-down restructures that have dominated the last decade of the NHS.”

So said David Cameron in 2009, and many were convinced.

Voters made Mr Cameron prime minister in2010 inpart because the Conservative Party cut into Labour's lead on health care,

which it had enjoyed almost since it founded the NHS in 1948. The Tories quickly squandered³ their advantage.

But their legacy⁴ will be better than they seem to believe.

In spite of his promise, Mr Cameron's Conservative-Liberal Democrat⁵ coalition⁶ government embarked⁷ on reforms that would reshape the NHS from the top down.

The immense Health and Social Care Act of 2012 increased competition,

gave the service greater autonomy and put more decisions about the purchase of care in the hands of local doctors,

known inBritainas general practitioners⁸, or GPs. The changes were so big that they could be seen from space,

quipped Sir David Nicholson, the departing head of the NHS.

The government soon came to wish they would disappear.

The reforms were never popular with a bemused public.

Doctors' groups argued they would lead to a more fragmented and privatised system.

Others worried that GPs would be incapable⁹ of commissioning care.

Ed Miliband, Labour's leader, dubbed¹⁰ the reforms Mr Cameron's “poll tax”, a reference to the policy that helped fell Margaret Thatcher¹¹.

In this case it was Andrew Lansley, the health secretary, who fell.

Less than six months after his reforms were passed, Mr Lansley was replaced by Jeremy Hunt, who talks about them as little as possible.

The health reforms were supposed to make the NHS more independent.

Yet Mr Hunt now styles himself a patients' champion—he is known to ring hospitals to ask about waiting times.

This is a concession¹² to reality: politicians will always be held accountable for the performance of the NHS.

Still, the frantic¹³ smothering¹⁴ of the reforms conceals¹⁵ something useful.

A policy that has caused the government so much embarrassment¹⁶ is quietly bearing fruit.

The biggest change was the creation of 211 Clinical Commissioning Groups (CCGs),

which placed about 60% of the NHS budget in the hands of local doctors and health workers.

They became responsible for procuring¹⁷ hospital care, mental-health services and the like.

Navigating¹⁸ a muddled¹⁹ system, the cannier²⁰ ones have figured out ways to realign the incentives²¹ of hospitals,

which are often paid per procedure, with those of GPs, who aim to keep people healthy and at home.

The commissioning group in Bedfordshire, for example, has bundled some 20 contracts for musculoskeletal care

(treatment for things like weak knees and cracked hips) into one five-year contract that was won by Circle, a commercial health group.

Far from fragmenting the system, as critics had feared, this has made Circle responsible for integrating the services of local providers.

Patients will be told which are doing best. Circle and its partners must achieve an agreed set of outcomes to receive some of their pay.

Paolo Pieri, Circle's chief financial officer, expects the deal will not only improve care but save Bedfordshire some ￡30m($50m).

Not all commissioning groups are as bold. But perhaps a quarter are considering contracts like the one in Bedfordshire, reckons Mr Pieri.

Diane Bell, a doctor there, says more than 40 CCGs have contacted her group.

“Every CCG I look at is doing brave and innovative²² work,” says Shane Gordon, who heads one inEssex.

The Labour Party—which launched a series of NHS reforms during its 13 years in power—says this sort of innovation was on the way anyway,

and may have been delayed. Thanks to the giant restructuring of the NHS “we lost two or three years”,

says Andy Burnham, the shadow health secretary. He also criticises a regulatory regime that leaves many providers confused.

Fair enough. But the reforms replaced bureaucrats²³ with clinicians, which seems to have encouraged creative thinking.

Dr Bell was warned by an old hand that outcomes-based contracting would stir up a fight in her group.

When she suggested it, though, the other GPs quickly bought in.

If Labour wins the next election, Mr Miliband might ground CCGs just as they are taking flight.

Although he has no plans to restructure the NHS yet again, his laudable aim of integrating health and social care,

which currently falls outside the NHS's remit²⁴, would probably shift responsibility to a different local body.

Mr Burnham would also clip the wings of reformers by giving NHS providers a built-in advantage in the competition for contracts.

But the biggest threat to CCGs and what some of them are doing to improve services is not politics but whether they can move fast enough to keep in front of a funding squeeze,

says Thomas Cawston of Reform, a think-tank. Though the NHS has been protected from the worst of austerity,

it could fall short by ￡30 billion by 2020—the result of rising demand from a growing elderly population.

Sir David warns that without more cash, the service could tip into the red next year.

As money runs short, the real test will arrive. It could be an opportunity for health reformers.

Or bureaucrats could panic and revert²⁵ to old ways. Whatever happens, the next government will not be able to duck the issue.

1 tiresome   

adj.令人疲劳的，令人厌倦的

参考例句：

• His doubts and hesitations were tiresome.他的疑惑和犹豫令人厌烦。
• He was tiresome in contending for the value of his own labors.他老为他自己劳动的价值而争强斗胜，令人生厌。

2 meddlesome   

adj.爱管闲事的

参考例句：

• By this means the meddlesome woman cast in a bone between the wife and the husband.这爱管闲事的女人就用这种手段挑起他们夫妻这间的不和。
• Get rid of that meddlesome fool!让那个爱管闲事的家伙走开！

3 squandered   

v.（指钱，财产等）浪费，乱花( squander的过去式和过去分词 )

参考例句：

• He squandered all his money on gambling. 他把自己所有的钱都糟蹋在赌博上了。
• She felt as indignant as if her own money had been squandered. 她心里十分生气，好像是她自己的钱给浪费掉了似的。 来自飘（部分）

4 legacy   

n.遗产，遗赠；先人(或过去)留下的东西

参考例句：

• They are the most precious cultural legacy our forefathers left.它们是我们祖先留下来的最宝贵的文化遗产。
• He thinks the legacy is a gift from the Gods.他认为这笔遗产是天赐之物。

5 democrat   

n.民主主义者，民主人士；民主党党员

参考例句：

• The Democrat and the Public criticized each other.民主党人和共和党人互相攻击。
• About two years later,he was defeated by Democrat Jimmy Carter.大约两年后，他被民主党人杰米卡特击败。

6 coalition   

n.结合体，同盟，结合，联合

参考例句：

• The several parties formed a coalition.这几个政党组成了政治联盟。
• Coalition forces take great care to avoid civilian casualties.联盟军队竭尽全力避免造成平民伤亡。

7 embarked   

乘船( embark的过去式和过去分词 )； 装载； 从事

参考例句：

• We stood on the pier and watched as they embarked. 我们站在突码头上目送他们登船。
• She embarked on a discourse about the town's origins. 她开始讲本市的起源。

8 practitioners   

n.习艺者，实习者( practitioner的名词复数 )；从业者（尤指医师）

参考例句：

• one of the greatest practitioners of science fiction 最了不起的科幻小说家之一
• The technique is experimental, but the list of its practitioners is growing. 这种技术是试验性的，但是采用它的人正在增加。 来自辞典例句

9 incapable   

adj.无能力的，不能做某事的

参考例句：

• He would be incapable of committing such a cruel deed.他不会做出这么残忍的事。
• Computers are incapable of creative thought.计算机不会创造性地思维。

10 dubbed   

v.给…起绰号( dub的过去式和过去分词 )；把…称为；配音；复制

参考例句：

• Mathematics was once dubbed the handmaiden of the sciences. 数学曾一度被视为各门科学的基础。
• Is the movie dubbed or does it have subtitles? 这部电影是配音的还是打字幕的？ 来自《简明英汉词典》

11 thatcher   

n.茅屋匠

参考例句：

• Tom Sawyer was in the skiff that bore Judge Thatcher. 汤姆 - 索亚和撒切尔法官同乘一条小艇。 来自英汉文学 - 汤姆历险
• Mrs. Thatcher was almost crazed; and Aunt Polly, also. 撒切尔夫人几乎神经失常，还有波莉姨妈也是。 来自英汉文学 - 汤姆历险

12 concession   

n.让步，妥协；特许(权)

参考例句：

• We can not make heavy concession to the matter.我们在这个问题上不能过于让步。
• That is a great concession.这是很大的让步。

13 frantic   

adj.狂乱的，错乱的，激昂的

参考例句：

• I've had a frantic rush to get my work done.我急急忙忙地赶完工作。
• He made frantic dash for the departing train.他发疯似地冲向正开出的火车。

14 smothering   

（使）窒息， （使）透不过气( smother的现在分词 )； 覆盖； 忍住； 抑制

参考例句：

• He laughed triumphantly, and silenced her by manly smothering. 他胜利地微笑着，以男人咄咄逼人的气势使她哑口无言。
• He wrapped the coat around her head, smothering the flames. 他用上衣包住她的头，熄灭了火。

15 conceals   

v.隐藏，隐瞒，遮住( conceal的第三人称单数 )

参考例句：

• He conceals his worries behind a mask of nonchalance. 他装作若无其事，借以掩饰内心的不安。 来自《简明英汉词典》
• Drunkenness reveals what soberness conceals. 酒醉吐真言。 来自《简明英汉词典》

16 embarrassment   

n.尴尬；使人为难的人(事物)；障碍；窘迫

参考例句：

• She could have died away with embarrassment.她窘迫得要死。
• Coughing at a concert can be a real embarrassment.在音乐会上咳嗽真会使人难堪。

17 procuring   

v.（努力）取得， （设法）获得( procure的现在分词 )；拉皮条

参考例句：

• He was accused of procuring women for his business associates. 他被指控为其生意合伙人招妓。 来自辞典例句
• She had particular pleasure, in procuring him the proper invitation. 她特别高兴为他争得这份体面的邀请。 来自辞典例句

18 navigating   

v.给（船舶、飞机等）引航，导航( navigate的现在分词 )；（从海上、空中等）横越；横渡；飞跃

参考例句：

• These can also be very useful when navigating time-based documents, such as video and audio. 它对于和时间有关的文档非常有用，比如视频和音频文档。 来自About Face 3交互设计精髓
• Vehicles slowed to a crawl on city roads, navigating slushy snow. 汽车在市区路上行驶缓慢，穿越泥泞的雪地。 来自互联网

19 muddled   

adj.混乱的；糊涂的；头脑昏昏然的v.弄乱，弄糟( muddle的过去式)；使糊涂；对付，混日子

参考例句：

• He gets muddled when the teacher starts shouting. 老师一喊叫他就心烦意乱。
• I got muddled up and took the wrong turning. 我稀里糊涂地拐错了弯。 来自《简明英汉词典》

20 cannier   

精明的，狡猾的( canny的比较级 )

参考例句：

• We should carry out the policy of integrating unified planning with the principle of adaptation to local conditions. 我们应该执行计划同因事制宜的原则相结合的政策。
• Talks will now begin about integrating the activities of both companies. 关于合并两家公司业务的谈判现在将会开始。

21 incentives   

激励某人做某事的事物( incentive的名词复数 )； 刺激； 诱因； 动机

参考例句：

• tax incentives to encourage savings 鼓励储蓄的税收措施
• Furthermore, subsidies provide incentives only for investments in equipment. 更有甚者，提供津贴仅是为鼓励增添设备的投资。 来自英汉非文学 - 环境法 - 环境法

22 innovative   

adj.革新的，新颖的，富有革新精神的

参考例句：

• Discover an innovative way of marketing.发现一个创新的营销方式。
• He was one of the most creative and innovative engineers of his generation.他是他那代人当中最富创造性与革新精神的工程师之一。

23 bureaucrats   

n.官僚( bureaucrat的名词复数 )；官僚主义；官僚主义者；官僚语言

参考例句：

• That is the fate of the bureaucrats, not the inspiration of statesmen. 那是官僚主义者的命运，而不是政治家的灵感。 来自辞典例句
• Big business and dozens of anonymous bureaucrats have as much power as Japan's top elected leaders. 大企业和许多不知名的官僚同日本选举出来的最高层领导者们的权力一样大。 来自辞典例句

24 remit   

v.汇款，汇寄；豁免（债务），免除（处罚等）

参考例句：

• I hope you'll remit me the money in time.我希望你能及时把钱汇寄给我。
• Many immigrants regularly remit money to their families.许多移民定期给他们的家人汇款。

25 revert   

v.恢复，复归，回到

参考例句：

• Let us revert to the earlier part of the chapter.让我们回到本章的前面部分。
• Shall we revert to the matter we talked about yesterday?我们接着昨天谈过的问题谈，好吗？