经济学人215:越南卫生保健 一路跛行

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　　越南卫生保健

　　Limping along

　　一路跛行

　　Ordinary folk are sick and tired of their public hospitals

　　老百姓厌烦了公立医院

　　Full to overflowing¹

　　完全超载

　　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.

　　该肿瘤是恶性的吗？阮霍特的医生们无法确认，他们所属的公立医院缺乏相应的脑部扫描仪。霍特毫无选择，只能坐在姐姐的摩托后座上从她所在的村庄驱车130km前往首都人满为患的公立医院治疗。然而如果不在她的家乡治疗，国家保险政策就只能报销所有医疗消费的30%。霍特是一个米农，用在验血和脑部检查上的150美元等同于她一个月的收入。

　　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.

　　提供医疗保险是政府的分内事。早在1945年宣布国家独立之前，在二十世纪二十年代，越南共产党就承诺了卫生部门改革。甚至在先后与法国和美国交战时，越南开发出了公共财政支持的医保体系。关于医保的规定应为共产党正统性的基石之一。

　　越南卫生保健.jpg

　　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.

　　但是医保体系如同越南的国家主导经济一样举步维艰。国家将GDP的3% 用在医保体系上，但不足以改善健康困境。医院的设备过时，其官僚作风也令人发指。2008年旨在扶持穷人和少数民族所通过的医保法案就太过复杂。然而政府明白，保障社保是预防威胁其统治的社会不安定因素的关键。

　　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.

　　一些改革正在进行中。政府给了一些医院更多的自主权。并且在6月是，国家共同通过了保险法的新版本，强制民众参加医保法案。旨在诱导长期不付保金的贫困户和黑市工人参保。

　　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.

　　然而人们对该体系积怨已深。一些公立医院为迎合富有的病人设立了崭新的设备，这些设备却很少能去满足多数人的需求。尤其是在涌满乡村而来的病人的城市病房内，共用一张病床十分普遍。

　　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.

　　尽管越南是专制国家，越南人仍对社会话题直言不讳。在健康方面，他们抱怨在当今风气下，医疗交易上半数的费用都用于“塞红包”。许多费用事实上用在了正规医药费之外。对他们而言，除了那些最有钱的病人，普通病人的支付能力比病人的需求更为重要，。举一典例，河内大学的讲师表示，当她在公立妇女医院生产时曾为能得到悉心照料，塞给了医生护士们约250美元。她说，按比例细算，注射1美元，洗澡2美元，免排队5美元。

　　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.

　　今年，卫生部长阮氏金因一系列健康方面的丑闻而受到强烈谴责，其中包括一场致死100个孩子的麻疹爆发。数千人在网上要求其辞职。一档知名的电视节目讽刺地建议人们可以通过自救以远离受贿的医生们。责任也并非全在官员们和医生们身上；通常来说，他们每月也只能拿到仅仅100美元。

　　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.

　　为了谋生，潜伏在私立医院和诊所中的医生来到了各个城市中给外国人和富裕的本国人治病，首选是河内和胡志明市，病人们若不在此，则会选择在新加坡或在香港就诊。越南国际医院就是这样一个机构，房地产开发商潘日旺赞助了600个床位。医院主管表示私立医院缓解了其他医院的拥挤。他们展现了国际保健的水准，并可能在某一天推广到公共医疗部门。

　　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.

　　这并不能慰藉阮霍特，这个长了脑瘤的米农。她说如果他的肿瘤是癌的话，就得从住在河内的哥哥姐姐那儿借钱治病了。她的家庭陷入了焦虑。她还说，更贫穷的邻居们选择更少。她觉得自己算是幸运的。

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