評論
打印
Private health care
私人醫療保健
The problem-solvers
問題的解決者
Hints of how to provide better health care for less money
有關花更少的錢獲得更多的醫療保健的建議
CHENMED doesn't look like much. Its clinic north ofMiamihas a modest waiting area and circle of examination rooms. But every action is engineered and tracked. Jennifer Thomas, a senior executive, pores over data. Whiteboards on her walls are covered with diagrams, a vestige from her days at McKinsey, a consultancy. “We've kind of figured it out,” she says.
CHENMED這家公司看起來和其他公司不太一樣。它在邁阿密以北的一個診所里，不僅有一個舒適的等候室，還有一個圓形的監查區。然而他們的每一個行動都是被好好設計和跟蹤的。高級主管陣妮佛·托馬斯。她墻上的白板上畫滿了圖表，這是她在麥肯錫咨詢公司工作時留下的習慣。“我們搞懂了這件事。”她說。
“It” is how to care for the most expensive patients in the world's most expensive health system. ChenMed is devoted to poor elderly people who may have half a dozen chronic conditions. It profits when they are kept well and their health-care costs are kept low. Clinics like ChenMed are the exception, not the rule. But the company is one of many that provide a hint of how American health care might work better.
“這件事”是指如何在世界上最昂貴的醫療系統下照顧診費最高的病人。ChenMed致力于照看那些全身都是慢性疾病的貧困老年人。只有把人照顧得好且所用醫療費用低時公司才能獲利。像ChenMed這樣的診所是一個特殊的例子，不是普遍地規律。然而這家公司和其他眾多的公司一樣，可以為美國醫療體制更好地運行提供一些建議。
ChenMed is led by Christopher Chen, a doctor and the son of the company's founder, a Taiwanese immigrant. Other members of the Chen family hold senior positions, but they have been joined by high-flying executives and management consultants, lured by ChenMed's model and the promise of profits as the company grows.
ChenMed是由臺灣移民克里斯托弗·陳領導的。他是公司創始人的兒子，同時也是一名醫生。陳家族的其他職員都持有高級職位，ChenMed向他們展示了公司未來的發展模型，并保證隨著公司的發展，利潤會不斷增加。他們被此吸引，加入了該公司，成為了雄心勃勃的公司高管和管理顧問。
The idea is simple. Medicare, the public health programme for the elderly, has a growing share of patients who use government money to buy private insurance. ChenMed contracts with those insurers, most of which pay a capped rate for each patient, and then plies patients with primary care to keep them out of hospital. ChenMed has vans to take patients to and from its clinics—lack of transport often keeps elderly patients from seeing their doctors. Once at the clinic, patients wave a card at the front desk and are automatically checked in. Staff perform a tightly choreographed routine, with data fed back to Ms Thomas and others to find further improvements.
這個想法很簡單。由于針對老年人的醫療保險和公共衛生計劃的不斷發展，越來越多的患者拿政府的錢來購買私人保險。ChenMed和那些保險公司簽訂合同，其中大部分為每位患者支付一個最高金額，然后為患者配備初級的護理，讓他們出院。ChenMed還有專用的貨車帶患者往返于患者的住處和診所，因為缺乏交通工具是阻礙老年患者就醫的一個常見問題。到了診所，患者在前臺刷卡就能自動登記。員工遵循一個嚴格設計過的步驟，然后把數據反饋給托馬斯女士和其他人，以便尋求進一步改善。
Examination rooms circle a central hub so that doctors can confer easily with assistants and specialists. A mobile app lets doctors see patients' medical records and refer to clinical protocols. The clinic has a pharmacy, so doctors give patients pills directly and answer any questions; failing to take medicine often sends patients to hospital. Most administration is centralised elsewhere, so staff at the clinic devote their attention to treatment.
監察室環繞著一個中心呈圓形排列，這樣醫生可以方便地和助手和專家探討問題。一個移動應用程序能讓醫生看到患者的醫療記錄并參考臨床方案。不按時吃藥是患者在醫院反復折騰的重要原因之一，所以，診所配有自己的藥房，醫生可以直接給患者開藥并回答患者提出的所有問題。大部分政府部門的精力都集中在其他地方，所以診所的員工專注于治療。
This seems to work. Medicare patients at ChenMed spent nearly 40% fewer days in hospital than the national average. Thanks to a venture with Humana, a big insurer, it has expanded to three dozen clinics. Dr Chen is bullish. “We don't see why we can't grow by 300% to 400% over the next five years,” he says.
這樣做似乎很有效果。在ChenMed就醫的醫療保險患者相比全國水平而言，在醫院少呆了40%的時間。由于一個大保險公司胡瑪納的加入，ChenMed名下已經有兩36家診所，陳博士很樂觀，他說“我們不明白我們為什么不能在未來的五年內增長300%到400%。”
