[2008.08.16] 全球化和健康：进口竞争

Globalisation and health
全球化和健康

Importing competition
进口竞争

Aug 14th 2008
From The Economist print edition

The coming boom in medical travel could help both rich and poor
无论对于富人还是穷人，即将到来的医疗旅行热潮皆有裨益

HEALTH care has long seemed one of the most local of all industries. Yet beneath the bandages, globalisation is thriving. The outsourcing of record keeping and the reading of X-rays is already a multi-billion-dollar business. The recruitment of doctors and nurses from the developing world by rich countries is also common, if controversial. The next growth area for the industry is the flow of patients in the other direction-known as “medical tourism”-which is on the threshold of a dramatic boom.
长久以来，医疗行业被认为是所有行业中最本地化的几个行业之一。但绷带之下，全球化浪潮正风起云涌。档案保存介质的海外采购和X片的解读已然形成了一个几十亿美元的产业。富裕国家从发展中国家招募医生和护士也比较常见，但引起了争议。医疗行业的下一个增长领域则是病人的反向流动–以”医疗旅游”而为人熟知–目前它即将迎来其发展高峰。

Tens of millions of middle-class Americans are uninsured or underinsured and soaring health costs are pushing them and cost-conscious employers and insurers to look abroad for savings (see article). At the same time the best hospitals in Asia and Latin America now rival or surpass many hospitals in the rich world for safety and quality. On one estimate, Americans can save 85% by shopping around and the number who will travel for care is due to rocket from under 1m last year to 10m by 2012-by which time it will deprive American hospitals of some $160 billion of annual business.
数百万美国中产阶级人士没有购买保险或购买的保险覆盖范围不大，此外，飞速增长的医疗开支也促使他们和一些对开支敏感的雇主及保险公司转向海外以求减少开支。与此同时，亚洲和拉美最好的医院也以其安全和质量而与富裕国家的医院不分伯仲，甚至略胜一筹。有人估计，美国人到其它国家购物可以节省85%的开销，赴海外就医的人数也将飞速增长，由去年的100万增至2012年的1000万。届时，美国医院每年将损失约1600亿美元。

Brain drain or net gain?
人才流失或净赚？

The coming boom has its critics. Some worry that a flood of foreigners into developing countries will divert money and expertise from state health systems that are already overwhelmed-an internal brain drain that will worsen care for ordinary people. Others decry it as a distraction from the need to cut costs and improve quality in rich-world health systems.
许多人对这个即将到来的热潮持批评态度。有人担心这股热潮会把专家和资金从本已陷入困境的国立医疗系统吸引到发展中国家–这种国内人才流失令普通民众的医疗状况进一步恶化。还有人认为富裕国家的医疗系统应该致力于削减成本、提高质量，而上述热潮却改变了这一进程。

But the private sector cannot be blamed for the failings of state-run health bureaucracies in developing countries, which neglected the poor long before medical tourists arrived. And the foreigners’ arrival could improve things in developing countries, for the poor as well as the rich. Although the hospitals that cater to medical tourists will of course employ local staff, they will also create jobs, tempt home émigré doctors and nurses, encourage locals to train as medics, spread know-how and treat local people.
在医疗旅游热潮兴起之前，长久以来发展中国家的国营医疗系统都忽视了穷人，而私营部门不应为此负责。此外，外国人的到来对发展中国家的穷人和富人皆有益处。尽管医院会迎合医疗游客，但他们肯定也会雇佣当地员工，会创造就业岗位，吸引移居国外的医生和护士，鼓励当地民众学医，传播医学知识并医治当地民众。

The flight of America’s “medical refugees” is indeed a symptom of a troubled health system back home. Yet medical tourism need not be a distraction from necessary reforms, but could be a catalyst to them. The prospect of losing revenues to India or Thailand is already shocking hospital administrators and insurers into raising standards, increasing price transparency and lowering costs. It may even bring the growing political pressure for reform to a head.
来自美国的”医疗难民”实际上是其国内医疗系统问题重重的一个表征。医疗旅游热潮不一定会喧宾夺主，阻碍必需的医疗改革进程，相反，它很可能会促进医疗改革。美国医院的营业收入可能会流向印度和泰国，这一前景深深触动了医院管理层，他们已经改善了医疗质量，提高了收费透明度，降低了医疗支出。它甚至可能进一步加大日益高涨的要求改革的政治压力，使得医疗改革势在必行。

If medical tourism is to live up to this promise, several barriers must first be swept away. In parts of America arcane restrictions still forbid out-of-state doctors from consulting with patients on the internet or by phone, which inhibits follow-up care for medical tourists. Legal and insurance barriers make it hard for employers to give employees a financial incentive to choose medical tourism over local options-even though insurers are allowed to offer such incentives to prompt patients to pick cheaper doctors inside America.
医疗旅游若想不负此托，首先必须清除几个障碍。美国一些地方仍有令人费解的规定，禁止境外医生通过网络或电话向患者提供咨询，这从而也阻止了更进一步向医疗游客提供治疗的可能。根据一些法律条款和保险条例，即使保险公司可以设立激励措施，鼓励患者选择美国境内收费更低的医生，但雇主却很难从金钱上刺激员工，以促使他们放弃本地医疗而选择医疗旅游。

In developing countries, the system for training doctors and nurses is often monolithic and state-financed. That makes it hard for the private-sector medical business to grow without depleting state coffers. A sensible model is the one employed in the Philippines, which allows nurses to work in the private sector or abroad if they repay their student loans. And part of the financial windfall which sick foreigners could bring to poor countries that welcome them should be spent on medical care for the poorest. If governments make the best of the boom, then medical tourism should improve the health of rich and poor alike.
在发展中国家，医生和护士的培训系统通常由国家资助并垄断。如果不削减国有资本，私营医疗产业就很难获得发展。菲律宾的模式比较合理，护士可以在私营医疗机构工作，但该机构须支付护士的培训费用。国外患者所带来的额外收入必须有一部分用于极端贫穷人口的医疗保健。如果政府好好利用这次医疗旅游热潮，那么它应该对富人和穷人的医疗保健都有益处。

译者：dgrkl     http://www.ecocn.org/forum/viewthread.php?tid=13340&extra=page%3D1