财富杂志 新加坡如何做到超低价优质医疗服务?(4)

What about single-payer systems such as those in Canada, the U.K., France and elsewhere?

加大拿、英国、法国和其他国家的单一支付制度怎么样呢？

Flynn bluntly shows how they control expenses: by rationing¹. You wait and wait to visit a specialist and,

弗林直白地展示了他们是如何控制开支的：通过限额配给。你等了很久才等到专科医师

depending on your age and condition, you may not be treated at all.

而根据你的年龄和状况，你或许根本得不到治疗。

Could a free-market health-care approach work in the U.S.? Of course.

自由市场卫生保健方法在美国行得通吗？当然。

Two examples where this is already being used are elective cosmetic² surgeries and LASIK eye surgeries, which aren't covered by insurance.

已经在使用的两个例子是选择性整容手术以及镭射视力矫正手术，这两项都不包括在医保里。

Nonetheless, demand for both has zoomed³. Results? Outcomes have improved, and prices, adjusted for inflation,

尽管如此，对这两项手术的需求都大幅上升。结果呢？在过去20年里，手术效果得到提升，

have dropped by almost 50% for LASIK operations and 25% for cosmetic procedures over the past 20 years.

受通胀影响，镭射视力矫正手术价格下降仅50%，整容手术下降25%。

The state of Indiana provides another example.

印第安纳州提供了另一个例子。

Back in 2007 it offered state employees the option of taking a high-deductible policy with a health savings⁴ account (HSA).

回到2007年，其为州员工提供了一种高免赔额的健康储蓄账户（HSA）选择。

The deductible was $2,750, with Indiana putting that amount each year into the employee's HSA,

免赔额是2750美元，印第安纳州每年都把这笔钱存入员工的HSA，

which became the employee's personal property. The worker would pay 20% of costs above that, up to $8,000; anything above that was covered 100%.

成为员工的个人财产。超出免赔额的部分，员工需要支付20%，可高达8000美元；超出部分全由保险公司支付。

The total out-of-pocket expense in a year was thus capped at a bit more than $1,000.

因此，一年的自付费用总额上限为1000美元多一点。

Employees in this plan reduced their spending 35%, because they suddenly had an incentive⁵ to get value for their health-care dollars,

参与该计划的员工减少了35%的支出，因为他们突然有了让医疗费用有价值的动力，

such as choosing generic⁶ drugs over the more expensive brand names

比如选择仿制药而非更加昂贵的品牌药

and visiting acute-care clinics instead of rushing to a more costly⁷ hospital emergency room.

以及去急性病治疗诊所看病，而不是急着去昂贵的医院急诊室。

Flynn's irrefutable bottom line: We should vigorously pursue high-deductible health insurance policies with HSAs

弗林无可辩驳的底线：我们应该大力推行HSAs这种高免赔额健康保险政策，

that would cover the deductible and be paid for by the employer, combined with posted prices for everything offered by providers.

由雇主支付免赔额，且医疗提供方要公布一切开支的价格。

Conditions may be ripe for such a profound change. Employers are already going for high-deductible policies,

进行这种深刻变革的条件或许已经成熟。雇主们已经在争取高免赔额的政策，

but many are not attaching them to robust⁸ HSAs. In addition, HSAs are hobbled by unnecessary restrictions⁹,

但许多人并没有把它们纳入到强有力的HSAs中。此外，不必要的限制使HSAs的实施并不顺利，

such as a ban on using them for over-the-counter medicines.

比如禁止使用HSAs购买非处方药。

As a start, Washington should require insurers to offer such policies in addition to their traditional ones and should remove those HSA constraints¹⁰.

首先，华盛顿应该要求保险公司在提供传统保险的基础上再提供这样的保险，并且应该取消那些HSA的限制。

By the way, Indiana is also successfully pioneering a Singapore-like approach for its Medicaid program.

此外，印第安纳州也为其医疗补助计划成功开创了一种新加坡式的方法。

1 rationing   

n.定量供应

参考例句：

• Wartime austerities included food rationing and shortage of fuel. 战时的艰苦包括食物配给和燃料短缺。
• Food rationing was abolished in that country long ago. 那个国家早就取消了粮食配给制。

2 cosmetic   

n.化妆品；adj.化妆用的；装门面的；装饰性的

参考例句：

• These changes are purely cosmetic.这些改变纯粹是装饰门面。
• Laughter is the best cosmetic,so grin and wear it!微笑是最好的化妆品，所以请尽情微笑吧！

3 zoomed   

v.（飞机、汽车等）急速移动( zoom的过去式 )；（价格、费用等）急升，猛涨

参考例句：

• Traffic zoomed past us. 车辆从我们身边疾驰而过。
• Cars zoomed helter-skelter, honking belligerently. 大街上来往车辆穿梭不停，喇叭声刺耳。 来自《简明英汉词典》

4 savings   

n.存款，储蓄

参考例句：

• I can't afford the vacation,for it would eat up my savings.我度不起假，那样会把我的积蓄用光的。
• By this time he had used up all his savings.到这时，他的存款已全部用完。

5 incentive   

n.刺激；动力；鼓励；诱因；动机

参考例句：

• Money is still a major incentive in most occupations.在许多职业中，钱仍是主要的鼓励因素。
• He hasn't much incentive to work hard.他没有努力工作的动机。

6 generic   

adj.一般的，普通的，共有的

参考例句：

• I usually buy generic clothes instead of name brands.我通常买普通的衣服，不买名牌。
• The generic woman appears to have an extraordinary faculty for swallowing the individual.一般妇女在婚后似乎有特别突出的抑制个性的能力。

7 costly   

adj.昂贵的，价值高的，豪华的

参考例句：

• It must be very costly to keep up a house like this.维修这么一幢房子一定很昂贵。
• This dictionary is very useful,only it is a bit costly.这本词典很有用，左不过贵了些。

8 robust   

adj.强壮的，强健的，粗野的，需要体力的，浓的

参考例句：

• She is too tall and robust.她个子太高，身体太壮。
• China wants to keep growth robust to reduce poverty and avoid job losses,AP commented.美联社评论道，中国希望保持经济强势增长，以减少贫困和失业状况。

9 restrictions   

约束( restriction的名词复数 )； 管制； 制约因素； 带限制性的条件（或规则）

参考例句：

• I found the restrictions irksome. 我对那些限制感到很烦。
• a snaggle of restrictions 杂乱无章的种种限制

10 constraints   

强制( constraint的名词复数 )； 限制； 约束

参考例句：

• Data and constraints can easily be changed to test theories. 信息库中的数据和限制条件可以轻易地改变以检验假设。 来自英汉非文学 - 科学史
• What are the constraints that each of these imply for any design? 这每种产品的要求和约束对于设计意味着什么？ 来自About Face 3交互设计精髓