是什么讓美國(guó)的醫(yī)療體系如此昂貴?(下)

Geoffrey Widdison
Why is healthcare so expensive in the USA?
Because the America doesn't have universal healthcare. Back in the 1940's when other wealthy countries started creating government programs to provide healthcare to everyone, a group of American health insurance companies got together and successfully lobbied against it here. Over the subsequent decades, they've only grown bigger, fatter and stronger, and continue to push against the idea, and their public relations campaign has helped to convince a large chunk of the country (and a larger chunk of the legislature) that privatized medicine is the only way to go.

美國(guó)的醫(yī)療費(fèi)用為何如此昂貴？
因?yàn)槊绹?guó)沒(méi)有實(shí)行全民醫(yī)保。在20世紀(jì)40年代，當(dāng)其他富裕國(guó)家開(kāi)始通過(guò)政府項(xiàng)目為所有人提供醫(yī)療服務(wù)時(shí)，一些美國(guó)健康保險(xiǎn)公司聯(lián)合起來(lái)，成功地在美國(guó)抵制了這一做法。在接下來(lái)的幾十年里，這些保險(xiǎn)公司不僅規(guī)模越來(lái)越大，而且力量也越來(lái)越強(qiáng)，他們繼續(xù)反對(duì)全民醫(yī)保的理念，并通過(guò)公關(guān)活動(dòng)成功說(shuō)服了大量美國(guó)人（以及更多的立法者）相信私營(yíng)醫(yī)療是唯一的選擇。
原創(chuàng)翻譯：龍騰網(wǎng) http://www.top-shui.cn 轉(zhuǎn)載請(qǐng)注明出處

Now, I'll point out that your numbers are off, but your basic premise is entirely correct. Depending on whose numbers you believe, the US spends 2-3 times more per capita on healthcare than the UK, and 50% more than Switzerland, which is the next most expensive major country. (https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita)

現(xiàn)在，我要指出你的數(shù)字是錯(cuò)誤的，但你的基本前提是完全正確的。根據(jù)不同的數(shù)據(jù)來(lái)源，美國(guó)在醫(yī)療保健上的人均支出是英國(guó)的2到3倍，比瑞士（在醫(yī)遼費(fèi)用方面，排美國(guó)之后最昂貴的主要國(guó)家）高出50%。（來(lái)源：各國(guó)人均醫(yī)療總支出列表）

There are a lot of reasons why this is, but most of them are directly connected to our privatized healthcare system. Hospitals, health insurance companies, and pharmaceutical companies are all private, profit-making entities. They're not incentivized to provide the most healthcare at the lowest cost, they're incentivized to maximum income. Pharma companies have a variety of strategies to get the most profitable drugs into the hands of consumers, hospitals are incentivized to fill beds, and insurance companies have to take a big chunk off the top as well. And beyond their profit margin, there are a whole bunch of inefficiencies when you have all of these companies working at cross-purposes. American hospitals and doctor's offices have to have billing departments, and often full-time employees specifically hired to work with the byzantine system of billing and collecting. That means that a staggering 30% of healthcare costs in America are spent, not on healthcare, but on overhead.

造成這種情況的原因有很多，但大多數(shù)都與我們的私營(yíng)醫(yī)療體系直接相關(guān)。醫(yī)院、健康保險(xiǎn)公司和制藥公司都是以盈利為目的的私營(yíng)企業(yè)。它們的目標(biāo)不是以最低成本提供最多的醫(yī)療服務(wù)，而是最大化收入。制藥公司采取各種策略將利潤(rùn)最高的藥物推向市場(chǎng)，醫(yī)院則鼓勵(lì)病人住院治療，保險(xiǎn)公司也要從中抽取相當(dāng)一部分利潤(rùn)。他們除了要利潤(rùn)之外，當(dāng)這些公司各自為政時(shí)，還會(huì)產(chǎn)生許多效率低下的問(wèn)題。美國(guó)醫(yī)院和診所需要設(shè)立計(jì)費(fèi)部門(mén)，并且經(jīng)常需要雇傭?qū)ｉT(mén)人員來(lái)處理復(fù)雜的計(jì)費(fèi)和收款系統(tǒng)。這意味著美國(guó)醫(yī)療成本中有高達(dá)30%并非用于醫(yī)療服務(wù)本身，而是用于管理開(kāi)銷。

There are a bunch of other effects, too. Insurances companies insulate people from the direct costs of individual procedures. The benefits are individualized, but the costs are spread out to the entire company, which is a recipe for costs going out of control. No one has a motive to decide whether procedures and drugs are actually necessary or not. At the same time, the litigious culture in America, with limited protections for doctors and hospitals results in what's known as "defensive medicine"; doctor's feel compelled to recommend every possible treatment and test so they don't risk getting sued if they miss something.
It's a lousy system, but the political structure of the United States makes it exceptionally difficult to change it. So, here we are.

還有其他一些影響因素。保險(xiǎn)公司使人們不受個(gè)別醫(yī)療程序直接費(fèi)用的影響。 但成本卻分?jǐn)偨o了整個(gè)公司，這很容易導(dǎo)致成本失控。沒(méi)有人有動(dòng)機(jī)去判斷治療和藥物是否真的必要。同時(shí)，美國(guó)的訴訟文化以及對(duì)醫(yī)生和醫(yī)院保護(hù)不足，導(dǎo)致了所謂的“防御性醫(yī)療”；醫(yī)生們感到必須推薦所有可能的治療和檢查，以防萬(wàn)一漏診而被起訴。
這是一個(gè)糟糕的體系，但美國(guó)的政治結(jié)構(gòu)使得改變它非常困難。因此，我們?nèi)匀惶幱谶@種狀況。

DR David Charles
The US healthcare system is expensive due to administrative inefficiencies, high prices for medical services and pharmaceuticals, fragmentation of care, defensive medicine practices, a significant uninsured population, and the prence of chronic diseases.

美國(guó)的醫(yī)療保健系統(tǒng)之所以成本高昂，是因?yàn)榇嬖谝韵乱蛩兀盒姓什桓摺⑨t(yī)療服務(wù)和藥品價(jià)格昂貴、醫(yī)療護(hù)理分散、防御性醫(yī)療行為普遍、有相當(dāng)數(shù)量的人口沒(méi)有保險(xiǎn)，以及慢性疾病的普遍性。

1-Administrative Costs: The US healthcare system has a complex administrative structure involving multiple insurance providers, billing systems, and administrative overhead. This complexity leads to higher administrative costs compared to systems with simpler administrative structures, such as single-payer systems High Prices for Medical Services and Pharmaceuticals: Medical services and prescxtion drugs tend to be more expensive in the US compared to other countries. This can be attributed to various factors, including the lack of price controls on medical services and pharmaceuticals, as well as the significant costs associated with research and development in the pharmaceutical industry.

行政成本：美國(guó)的醫(yī)療體系包含多個(gè)保險(xiǎn)公司、計(jì)費(fèi)系統(tǒng)和行政開(kāi)銷，構(gòu)成了一個(gè)復(fù)雜的行政管理架構(gòu)。這種復(fù)雜性使得其行政成本高于那些采用單一支付者制度的國(guó)家。
醫(yī)療服務(wù)和藥品價(jià)格高昂：美國(guó)的醫(yī)療服務(wù)和處方藥物價(jià)格通常高于其他國(guó)家，這主要是由于缺乏對(duì)醫(yī)療服務(wù)和藥品價(jià)格的管制，以及制藥行業(yè)在研發(fā)上的高額投入所致。

2-Fragmentation of Care: The US healthcare system is highly fragmented, with many different providers, insurers, and healthcare facilities operating independently. This fragmentation can lead to inefficiencies, duplication of services, and difficulty coordinating care, all of which contribute to higher costs.

醫(yī)療護(hù)理分散：美國(guó)醫(yī)療體系中存在眾多獨(dú)立運(yùn)作的醫(yī)療服務(wù)提供者、保險(xiǎn)公司和醫(yī)療機(jī)構(gòu)，這種分散化導(dǎo)致了效率低下、服務(wù)重復(fù)和協(xié)調(diào)困難，進(jìn)而增加了成本。

3-Defensive Medicine: Due to concerns about medical malpractice lawsuits, healthcare providers may engage in defensive medicine by ordering unnecessary tests and procedures to protect themselves from legal liability. This practice can drive up healthcare costs without necessarily improving patient outcomes. Uninsured and Underinsured Populations: A significant portion of the US population lacks health insurance or has inadequate coverage. When uninsured or underinsured individuals receive medical care, the costs may be shifted onto those with insurance through higher premiums and healthcare costs, further exacerbating the overall expense of the system.

防御性醫(yī)療行為：由于對(duì)醫(yī)療事故訴訟的擔(dān)憂，醫(yī)療提供者可能會(huì)進(jìn)行不必要的檢查和治療，以保護(hù)自己免受法律責(zé)任，這種做法增加了醫(yī)療成本，但并不一定能改善患者的治療效果。
沒(méi)有保險(xiǎn)和保險(xiǎn)險(xiǎn)種不足的人群:：美國(guó)有相當(dāng)一部分人沒(méi)有健康保險(xiǎn)或保險(xiǎn)覆蓋不足。這些人群在接受醫(yī)療時(shí)，其成本可能會(huì)轉(zhuǎn)嫁給有保險(xiǎn)的人，通過(guò)提高保險(xiǎn)費(fèi)和醫(yī)療費(fèi)用，進(jìn)一步增加了整個(gè)醫(yī)療體系的負(fù)擔(dān)。

4-Chronic Disease Management: The prence of chronic diseases in the US, such as diabetes, heart disease, and obesity, leads to higher healthcare costs. Managing chronic conditions requires ongoing medical care, medications, and sometimes hospitalization, all of which contribute to the overall expense of the healthcare system.

慢性疾病管理成本高：美國(guó)慢性疾病如糖尿病、心臟病和肥胖癥的普遍性，導(dǎo)致了更高的醫(yī)療成本。管理這些慢性疾病需要持續(xù)的醫(yī)療服務(wù)、藥物治療，有時(shí)還需要住院，這些都對(duì)醫(yī)療體系的總成本有顯著貢獻(xiàn)。

Scott Welch
Why is healthcare in the USA so expensive compared to other countries?
Well, the quick answer is that sick people will pay almost anything for a cure. And when the sick person is your child, you can add another zero on to that.
I will always remember a discussion I had with a colleague of mine when I was working in Mountain View in 1986. She was Russian, and in those days that was really, really rare — I think she defected from some sports team.
Anyhow we were discussing something about the health care system, medical bankruptcies I think, and I said “I can’t believe that a civilized country treats its citizens this way.”

為什么美國(guó)的醫(yī)療費(fèi)用比其他國(guó)家高那么多？
簡(jiǎn)單來(lái)說(shuō)，生病的人幾乎愿意為治療付出任何代價(jià)，如果是自己的孩子生病，他們甚至愿意多付十倍。
我記得1986年在山景城（美國(guó)加州）工作時(shí)，我和一位同事——她是俄羅斯人，那時(shí)候很少見(jiàn)，我想她可能是從某個(gè)運(yùn)動(dòng)隊(duì)逃出來(lái)的——討論過(guò)醫(yī)療保險(xiǎn)系統(tǒng)的問(wèn)題，可能是關(guān)于醫(yī)療破產(chǎn)的話題。我說(shuō)：“我真不敢相信一個(gè)文明國(guó)家會(huì)這樣對(duì)待它的公民。”

She got a very serious look on her face and then said something I’ve remembered all these years:
“Scott. You must always be remembering: This is not a civilized country.”
Viewed through this lens, there are a lot of things about America that make more sense.

她的表情突然變得非常嚴(yán)肅，然后對(duì)我說(shuō)了一番話，我至今記憶猶新：“斯科特，你必須永遠(yuǎn)記?。哼@個(gè)國(guó)家并不是一個(gè)文明國(guó)家。”
從這個(gè)視角來(lái)看，美國(guó)的很多事情就更加容易理解了。

Len Gould
I’ve long held that view. Economically successful yes, but since the 1980’s not civilized.
[Edit] Perhaps relevant is the thought that the “wild west” mentality common in many US citizens is evidence of never having been civilized.

我一直持有這種觀點(diǎn)。美國(guó)經(jīng)濟(jì)上確實(shí)成功，但自1980年代以來(lái)，它并不算是一個(gè)文明的國(guó)家。
編輯：或許值得一提的是，許多美國(guó)公民普遍存在的“狂野西部”心態(tài)，這表明他們從未真正文明過(guò)。

Kosta
This is what you get when you have a country founded by business men who were upset about taxes.

當(dāng)你的國(guó)家是由一群對(duì)稅收不滿的商人建立時(shí)，你就會(huì)得到這樣的結(jié)果。

Sandeep Albert Mathias
To be fair, they were not upset about taxes, but rather about them not having a say in those taxes. If I remember correctly, the slogan was “No taxation without representation,” not “No taxation. Period.”

公平地說(shuō)，他們不滿的不是稅收本身，而是他們對(duì)稅收沒(méi)有發(fā)言權(quán)。如果我沒(méi)記錯(cuò)的話，當(dāng)時(shí)的口號(hào)是“無(wú)代表，不納稅”，而不是“堅(jiān)決不納稅”。

Scott Welch
I believe it was Benjamin Franklin who said “Americans are fundamentally opposed to taxation without representation, and they are not very fond of taxation with representation either.”

我認(rèn)為是本杰明·富蘭克林說(shuō)過(guò)：“美國(guó)人基本上反對(duì)沒(méi)有代表權(quán)的稅收，不過(guò)即使有了代表權(quán)，他們對(duì)稅收也沒(méi)什么好感?！?/b>