評論
打印
Health care in Vietnam
越南衛(wèi)生保健
Limping along
一路跛行
Ordinary folk are sick and tired of their public hospitals
老百姓厭煩了公立醫(yī)院
Full to overflowing
完全超載
WAS the tumour malignant? 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 incurred 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 earnings.
該腫瘤是惡性的嗎？阮霍特的醫(yī)生們無法確認，他們所屬的公立醫(yī)院缺乏相應的腦部掃描儀。霍特毫無選擇，只能坐在姐姐的摩托后座上從她所在的村莊驅車130km前往首都人滿為患的公立醫(yī)院治療。然而如果不在她的家鄉(xiāng)治療，國家保險政策就只能報銷所有醫(yī)療消費的30%。霍特是一個米農(nóng)，用在驗血和腦部檢查上的150美元等同于她一個月的收入。
It is the job of the authorities to look after health care. The Communist Party of Vietnam first pledged health-sector 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 legitimacy is based.
提供醫(yī)療保險是政府的分內(nèi)事。早在1945年宣布國家獨立之前，在二十世紀二十年代，越南共產(chǎn)黨就承諾了衛(wèi)生部門改革。甚至在先后與法國和美國交戰(zhàn)時，越南開發(fā)出了公共財政支持的醫(yī)保體系。關于醫(yī)保的規(guī)定應為共產(chǎn)黨正統(tǒng)性的基石之一。
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 infrastructure. Hospitals have outdated facilities and maddeningly opaque bureaucracies. A law on health insurance passed in 2008, created to assist the poor and ethnic 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.
但是醫(yī)保體系如同越南的國家主導經(jīng)濟一樣舉步維艱。國家將GDP的3% 用在醫(yī)保體系上，但不足以改善健康困境。醫(yī)院的設備過時，其官僚作風也令人發(fā)指。2008年旨在扶持窮人和少數(shù)民族所通過的醫(yī)保法案就太過復雜。然而政府明白，保障社保是預防威脅其統(tǒng)治的社會不安定因素的關鍵。
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 participation compulsory. The idea is to lure into the fold poorer and black-market workers who have long avoided paying insurance.
一些改革正在進行中。政府給了一些醫(yī)院更多的自主權。并且在6月是，國家共同通過了保險法的新版本，強制民眾參加醫(yī)保法案。旨在誘導長期不付保金的貧困戶和黑市工人參保。
Yet distrust of the system runs deep. Some public hospitals have built flashy new wings which cater to well-heeled patients but do little to meet general demand. Bed-sharing is common, especially in urban wards flooded by patients from the countryside.
然而人們對該體系積怨已深。一些公立醫(yī)院為迎合富有的病人設立了嶄新的設備，這些設備卻很少能去滿足多數(shù)人的需求。尤其是在涌滿鄉(xiāng)村而來的病人的城市病房內(nèi)，共用一張病床十分普遍。
Though this is an authoritarian state, ordinary Vietnamese are remarkably outspoken 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 bribes paid on top of formal hospital fees. They mean that affordability 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 attentive treatment when she gave birth at a public maternity hospital. The rate, she says, was $1 per injection, $2 for a bath and $5 to sidestep a queue.
盡管越南是專制國家，越南人仍對社會話題直言不諱。在健康方面，他們抱怨在當今風氣下，醫(yī)療交易上半數(shù)的費用都用于“塞紅包”。許多費用事實上用在了正規(guī)醫(yī)藥費之外。對他們而言，除了那些最有錢的病人，普通病人的支付能力比病人的需求更為重要，。舉一典例，河內(nèi)大學的講師表示，當她在公立婦女醫(yī)院生產(chǎn)時曾為能得到悉心照料，塞給了醫(yī)生護士們約250美元。她說，按比例細算，注射1美元，洗澡2美元，免排隊5美元。
The health minister, Nguyen Thi Kim Tien, has faced blistering criticism this year after a parade of health scandals, including a measles outbreak that killed more than 100 children. Online, thousands have called for her resignation. A popular television satire advises sick patients to avoid corrupt 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，衛(wèi)生部長阮氏金因一系列健康方面的丑聞而受到強烈譴責，其中包括一場致死100個孩子的麻疹爆發(fā)。數(shù)千人在網(wǎng)上要求其辭職。一檔知名的電視節(jié)目諷刺地建議人們可以通過自救以遠離受賄的醫(yī)生們。責任也并非全在官員們和醫(yī)生們身上；通常來說，他們每月也只能拿到僅僅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 affluent Vietnamese, people who would otherwise opt 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.
為了謀生，潛伏在私立醫(yī)院和診所中的醫(yī)生來到了各個城市中給外國人和富裕的本國人治病，首選是河內(nèi)和胡志明市，病人們?nèi)舨辉诖耍瑒t會選擇在新加坡或在香港就診。越南國際醫(yī)院就是這樣一個機構，房地產(chǎn)開發(fā)商潘日旺贊助了600個床位。醫(yī)院主管表示私立醫(yī)院緩解了其他醫(yī)院的擁擠。他們展現(xiàn)了國際保健的水準，并可能在某一天推廣到公共醫(yī)療部門。
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.
這并不能慰藉阮霍特，這個長了腦瘤的米農(nóng)。她說如果他的腫瘤是癌的話，就得從住在河內(nèi)的哥哥姐姐那兒借錢治病了。她的家庭陷入了焦慮。她還說，更貧窮的鄰居們選擇更少。她覺得自己算是幸運的。
