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America's hospital industry
美國醫(yī)療行業(yè)
Taking a scalpel to costs
對醫(yī)療費(fèi)用動(dòng)動(dòng)刀
Hospital operators brace themselves for health-care reform
醫(yī)院負(fù)責(zé)人正為醫(yī)保制度改革做準(zhǔn)備
EARLIER this month America's hospital bosses gathered in Washington, DC, with vice-president Joseph Biden.
本月早些時(shí)候，美國醫(yī)院的領(lǐng)導(dǎo)者們和副總統(tǒng)Joseph Biden齊聚華盛頓。
To the amazement of many, they vowed to accept a cut of $155 billion in their expected revenues over the next decade as part of a grand bargain on health-care reform.
令人感到驚奇的是，他們鄭重同意在接下來的十年將預(yù)期收益削減1550億美元，作為醫(yī)療保健改革已取得的巨大成效中的一部分。
How can they justify giving away such a vast sum?
他們?yōu)槭裁磿?huì)同意放棄這么大一筆收益？
There are several explanations, not all of them altruistic.
對此有很多種解釋，他們的動(dòng)機(jī)也不全出于利他。
Taken together, they show that the industry's leaders are bracing themselves for a period of upheaval.
總之，他們已經(jīng)顯示出整個(gè)行業(yè)的領(lǐng)導(dǎo)人正積極應(yīng)對未來行業(yè)的大變動(dòng)。
For hospitals, the positive thing about health-care reform is that it is going to be good for business.
對醫(yī)院來說，醫(yī)保改革帶來的好處是它對商業(yè)有利。
It will be welcome news to an industry that is hardly in rude health.
改革對于一個(gè)不太健康的行業(yè)來說總是好事。
Despite two decades of consolidation, hospitals' finances remain anaemic; over a quarter of them regularly post negative operating margins.
誠然，醫(yī)保行業(yè)走過了二十年的穩(wěn)固期，但是醫(yī)院的財(cái)經(jīng)狀況仍舊不景氣，超過四分之一的醫(yī)院存在周期性虧損。
The recession is making things worse.
而且現(xiàn)在的經(jīng)濟(jì)危機(jī)更是加劇了形勢惡化。
Moody's, a credit-rating agency, notes that many patients are putting off non-essential treatments.
信貸評級機(jī)構(gòu)Moody's注意到很多患者正在推遲一些非必須的治療。
So any reforms that promise a flood of new demand for health services should be welcome.
因此任何可以使得醫(yī)療服務(wù)的需求大幅增長的改革承諾都應(yīng)該是大受歡迎的。
Rich Umbdenstock, the head of the American Hospital Association and one of the bosses who shared the stage with Mr Biden,
作為美國醫(yī)院協(xié)會(huì)會(huì)長的Rich Umbdenstock和與副總統(tǒng)Biden先生見面會(huì)談的領(lǐng)導(dǎo)人之一，
acknowledges that extending health insurance to most of America's nearly 50m uninsured will benefit his industry in the long term.
承認(rèn)從長遠(yuǎn)看來，為沒有享受醫(yī)保的五千萬美國人提供保險(xiǎn)將會(huì)使整個(gè)行業(yè)受益。
Those unfortunates still turn up at emergency rooms and often do not pay their bills.
這些沒有醫(yī)保的人們經(jīng)常出現(xiàn)在急診室里而且無力支付醫(yī)藥單。
The government gives hospitals some money to compensate them for this, but the AHA says it does not cover the full cost,
對此，政府會(huì)給醫(yī)院發(fā)放一定數(shù)額的資金以作彌補(bǔ)，但是美國醫(yī)院協(xié)會(huì)表示，這些金額不足以支付資金缺口。
which it put at $34 billion in 2007, up from $3.9 billion in 1980.
這些缺口已經(jīng)從1980年的39億上升到2007年的340億，
Paul Mango of McKinsey, a consultancy, estimates that the hospitals recover only 10-12% of this cost.
大約占醫(yī)院每年財(cái)政收入的5%。來自咨詢公司麥肯錫公司的Paul Mango估計(jì)，醫(yī)院大概只能收回這些資金的10-12%，
But he says the problem would be greatly reduced under a system of universal health-insurance which included subsidies for the indigent, as the proposed health reforms envisage.
但他也說，如果可以建立一個(gè)大部分人都享受醫(yī)保并且貧困人口得到補(bǔ)助的體制，這些資金缺口就可以被大大減少，而這種體制正是當(dāng)前的醫(yī)療改革嘗試建立的。
Herbert Pardes, chief executive of New York-Presbyterian, a research hospital, says the large numbers of underinsured patients, who frequently fail to pay their bills in full, cost hospitals still more.
Herbert Parades是紐約一家研究型醫(yī)院Presbyterian的總裁，他說，很多保額不足的病人不能全額支付他們的醫(yī)療花費(fèi)，這仍舊給醫(yī)院帶來越來越大的負(fù)擔(dān)。
The huge sums the hospitals stand to gain from reducing such losses make even $155 billion over ten years look like a reasonable amount of money to sacrifice to secure such a bonanza.
如果醫(yī)院在未來十年可以通過削減這種損失而獲得1550億的利潤，那么這樣的暫時(shí)性損失也是合理的。
But there are less virtuous reasons why the hospitals offered such a generous-sounding deal.
但是人們不知道醫(yī)院愿意放棄這樣一筆利潤的背后仍有很多不太高尚的原因。
As Mr Umbdenstock notes, it was less painful than the $225 billion or more in cuts that Barack Obama had been pressing for earlier in the year.
正如Umbdenstock先生所說，相比奧巴馬總統(tǒng)今年早些時(shí)候敦促的2250億甚至更多的財(cái)政削減計(jì)劃，現(xiàn)行的削支方案就沒有那么痛苦了。
This is a tacit acknowledgment that hospital chiefs were seeking to avert the one thing that strikes fear into their hearts: the spread of price controls.
醫(yī)院負(fù)責(zé)人們早已心照不宣地承認(rèn)，他們通過這樣的變通，正在努力避免物價(jià)被控制，這正是會(huì)令他們驚恐不安的事情。
Because of the creeping expansion of Medicare and Medicaid, the publicly funded health-care schemes for the elderly and the poor,
在美國，為老年病人和殘疾病人的國家醫(yī)療照顧體制正在慢慢向更多的公民擴(kuò)展，
the government already pays over half the bills at the average American hospital.
正因?yàn)槿绱耍骄聛碚呀?jīng)為每家醫(yī)院支付了超過半數(shù)的醫(yī)療費(fèi)。
But the political left is clamouring for a government-run insurance plan, to compete with private ones, as part of any reform effort.
但是政治左派卻在改革之中叫囂一個(gè)政府操作的保險(xiǎn)計(jì)劃，以此來和私人運(yùn)營計(jì)劃相抗衡。
The problem, argues Toby Cosgrove, chief executive of the Cleveland Clinic, a hospital group, is that the existing public schemes routinely underpay hospitals for care.
Toby Gosgrove是，一個(gè)名為Cleveland Clinic的理療團(tuán)體總裁，他說，這樣做的問題在于，現(xiàn)行的醫(yī)保體制總是使得醫(yī)院獲得不足額的補(bǔ)助。
Some economists question that claim.
一些經(jīng)濟(jì)學(xué)家對此持懷疑態(tài)度。
Even so, it is probably right to suggest,
盡管如此，正如Cosgrove醫(yī)生所建議的，
as Dr Cosgrove does, that any public insurance plan based on Medicare's pricing would squeeze hospitals hard and, as a result, require private insurers to cross-subsidise the bill.
依照目前國家醫(yī)療照顧體制的集款方式所運(yùn)營的任何公共保險(xiǎn)計(jì)劃都會(huì)使醫(yī)院出現(xiàn)資金困難，結(jié)果仍舊需要投保個(gè)人來買單。
In addition to a determination to head off any moves towards greater government control over prices,
采取此項(xiàng)改革的一個(gè)重要原因是醫(yī)院領(lǐng)導(dǎo)人們下定決心阻止政府對醫(yī)藥價(jià)格的進(jìn)一步控制，
another even less noble reason for offering the price cut was a desire to thwart a proposed change to the tax status of non-profit hospitals, which make up most of the national total of 5,700 or so.
相比而言另一個(gè)不怎么高尚的原因則是領(lǐng)導(dǎo)者們試圖通過減少削減開支來抵制改變非營利性醫(yī)院稅收政策的提案，非營利性醫(yī)院在全美有5700家之多。
On the ground that they provide charitable care, many religious and community hospitals have been granted an exemption allowing them to issue tax-free bonds,
由于很多宗教和社區(qū)醫(yī)院提供慈善性的救助，他們都享有稅收優(yōu)惠的政策，可以發(fā)放免稅證券，免收財(cái)產(chǎn)和收入稅收等等。
avoid taxes on property and income, and so on. But investigations by the Internal Revenue Service and others have revealed that many in fact provide very little charitable care, while paying enormous salaries or going on acquisition sprees.
但是美國國內(nèi)收入署和其他一些機(jī)關(guān)的調(diào)查表明，有些醫(yī)院提供很少的慈善性救助，他們所做的無非是領(lǐng)取高額工資，無節(jié)制地享受收益。
On this proposal, the industry may carry the day.
在這樣的提案下，整個(gè)行業(yè)的反對可能會(huì)占上風(fēng)。
Although the tax break is hard to defend, closing the loophole would lead to many small, weak hospitals shutting down—something voters would be unlikely to tolerate.
盡管人們很難為稅務(wù)減免而辯護(hù)，結(jié)束這樣的漏洞可能會(huì)導(dǎo)致很多小型醫(yī)院的倒閉，這正是選民們不能容忍的事情。
Even those hospitals that survived might spark a backlash.
甚至那些得以幸存的醫(yī)院也會(huì)引發(fā)人們強(qiáng)烈的反對。
Dr Pardes argues that abolishing the tax advantages would mean higher running costs that would inevitably be passed through to those patients who have private insurance.
Parades醫(yī)生說廢除稅收優(yōu)惠政策即意味著更高的運(yùn)作成本，這無疑將給那些擁有個(gè)人醫(yī)療保險(xiǎn)的病人施加經(jīng)濟(jì)負(fù)擔(dān)。
The other great fear of hospital bosses is being forced to accept greater competition.
醫(yī)院負(fù)責(zé)人們的另一個(gè)隱憂是被迫進(jìn)入激烈的行業(yè)競爭。
Although the industry is fragmented, Jon Scholl of the Boston Consulting Group points out that because pricing is done at city or regional level, there are local pockets of power.
波士頓咨詢集團(tuán)的Jon Scholl指出，現(xiàn)在的醫(yī)療行業(yè)處于支離破碎的狀態(tài)，由于定價(jià)的過程是在某一城市或地區(qū)范圍之內(nèi)完成的，本地權(quán)利口袋影響定價(jià)的行為是存在的。
Alain Enthoven, an economist at Stanford University's business school who helped inspire the managed health care movement of the 1990s, promoted an approach that succeeded in squeezing costs at the time,
Alain Enthoven是來自斯坦福大學(xué)商學(xué)院的經(jīng)濟(jì)學(xué)家，他曾經(jīng)在二十世紀(jì)90年代推動(dòng)管理醫(yī)保運(yùn)動(dòng)的開展。
but ultimately failed as patients rebelled against the restrictions it placed on their choice of doctors and treatments.
當(dāng)時(shí)他推行的改革方案在削減成本方面頗有成效，但因?yàn)椴』疾粷M他們失去了選擇醫(yī)生和療法的自由而抗議，這項(xiàng)改革以失敗告終。
Mr Enthoven argues that the consolidation that followed managed care has resulted in too little competition.
Enthoven先生認(rèn)為，改革失敗后的相對穩(wěn)固導(dǎo)致了今日幾無競爭存在的行業(yè)格局。
Antitrust action in the hospital field has been woefully weak, he says.
他說：反壟斷在醫(yī)療行業(yè)只是一句可悲的空話。
There are some innovative competitors emerging to challenge hospitals.
當(dāng)然還是有一些富有創(chuàng)新精神愿意挑戰(zhàn)壟斷的競爭者出現(xiàn)。
Paul Keckley of Deloitte, a consultancy, estimates that there are over 1,000 retail health clinics operating today at Wal-Mart stores,
Deloitte咨詢公司的Paul Keckley估計(jì)，在沃爾瑪?shù)赇仯琖algreen藥店還有其他的一些便利商店，總共有超過1000家藥品零售診所存在。
Walgreens pharmacies and other convenient locations, and their numbers are expected to multiply in the next few years.
在今后幾年，這些零售診所的數(shù)量有可能翻倍。
Some of these cheap and cheerful outfits are staffed by nurse practitioners, which incenses doctors and hospital bosses.
一些有醫(yī)師資格的護(hù)士在這里工作，他們的工資水平比醫(yī)師低很多，這讓醫(yī)生和醫(yī)院負(fù)責(zé)人們很是惱怒。
The nascent boom in medical tourism could also disrupt the hospital business,
但醫(yī)療旅游近期的初步興起還是困擾醫(yī)療行業(yè)的一個(gè)原因。
even if every hip-replacement patient does not actually go to India to get it done.
盡管不是每一個(gè)需要做髖關(guān)節(jié)置換手術(shù)的病人都選擇去印度治療，
Mr Keckley points out that in several parts of the country the mere introduction of insurance plans offering cheap surgery abroad has forced local hospitals to respond by slashing their prices—something unheard of in this industry.
Keckley先生指出，在美國的一些地方，出現(xiàn)了一些提供便宜海外手術(shù)的醫(yī)療保險(xiǎn)計(jì)劃，這就使得當(dāng)?shù)蒯t(yī)院不得不采取減價(jià)策略，但事實(shí)上，減價(jià)在醫(yī)療行業(yè)是前所未聞的事情。
Mr Enthoven argues that if reforms are done properly, they would force hospitals to get organised to compete and get more efficient.
Enthoven先生說，如果改革可以成功實(shí)施，那么這將促使醫(yī)院組織性更強(qiáng)的去參與行業(yè)競爭，而且將使整個(gè)行業(yè)提高效率。
Alas, the omens are not good.
但是，目前的預(yù)兆不太好。
One of the explicit concessions wrung by the hospital bosses from the White House was a promise to crack down on clinics owned by doctors.
醫(yī)院負(fù)責(zé)人們與政府方面協(xié)商出的一個(gè)明確讓步就是打擊私人醫(yī)生開設(shè)的診所。
These outfits are guilty of anti-competitive self-dealing, since the doctor has a financial motive to refer cases to his own firm,
因?yàn)獒t(yī)生們出于經(jīng)濟(jì)動(dòng)機(jī)可能會(huì)向自己的私人診所推薦病例，這些小診所違反了反競爭的自利交易原則，
but what hospital bosses were really concerned about was that such clinics are competing hard with them, and siphoning off the most profitable patients.
但事實(shí)上醫(yī)院負(fù)責(zé)人們真正擔(dān)心的問題是這些小診所正與大醫(yī)院激烈的競爭，大醫(yī)院可能因此失掉那些可以讓他們賺大錢的病例。
As this back-room deal illustrates, the strongest motives behind the hospitals' ostensibly generous price cut were self-serving ones: to reduce competition, not boost it,
正如這個(gè)密室協(xié)議所證明的，在醫(yī)院表面慷慨削減開支的背后，最真實(shí)的動(dòng)機(jī)卻是自我獲利：
and to head off any increase in government influence over their prices.
非但不促進(jìn)，反而減少競爭，并竭力避免任何可能出現(xiàn)的政府對價(jià)格的管制。
As health-care reform forges ahead, reformers are desperate to find cost savings and the hospital industry is a juicy target.
醫(yī)保改革就在眼前，改革者們將會(huì)失望的發(fā)現(xiàn)醫(yī)療行業(yè)減少開支的目標(biāo)很難實(shí)現(xiàn)。
So its bosses felt they had to cut a deal.
所以行業(yè)負(fù)責(zé)人們覺得他們必須做筆交易。
As Julius Hobson of Bryan Cave, a veteran health lobbyist, puts it: If you're not at the table, then you're on the menu.
Julius Hobson，是Bryan Cave公司的一個(gè)老兵健康游說者，現(xiàn)在的情形正如他所說：如果你不愿意主動(dòng)出擊，那你就等著被人利用吧。
