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肠胃炎-双语阅览|爱尔兰仰慕英国医疗系统却无法“复刻”

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AS THE UNITED KINGDOM prepares to slip its European moorings, the ties that bind it together are also under strain. In Northern Ireland, which (like Scotland) voted to remain, there is often talk that a “hard Brexit” could even build new momentum for a united Ireland. One reason for doubting this, however, can be summed up in a word: health.

英国预备甩手与欧洲的联系之际,能维系两者的联系处于紧张状态。在(与苏格兰相同)投票支撑留欧的北爱尔兰,常常有人说,“硬退欧”乃至会让爱尔兰共同气势鼓起。但是,对此质疑的一个原因能够归纳为:健康。

The 1.8m people of Northern Ireland enjoy free access to the British taxpayer-funded National Health Service (NHS). The Republic of Ireland’s 4.8m residents have to make do with something less appealing. “I know people up north whose life’s ambition is to see a united Ireland, and yet they worry when they see the health service we have down here,” says Louise O’Reilly, an MP in Dublin and health spokesperson for the all-island Sinn Fein party.

北爱尔兰有180万人口,能免费享用英国纳税人出资的国民健康服务(NHS)。爱尔兰共和国的480万居民不得不处理不那么吸引人的作业。 “我知道北爱人日子方针是看到一个共同的爱尔兰,但看到咱们这儿的医疗服务时,会感到忧虑,”都柏林议员兼全爱尔兰岛肠胃炎-双语阅览|爱尔兰仰慕英国医疗系统却无法“复刻”的新芬党卫生发言人路易斯奥莱利说。

Ireland’s relatively high spending on health care—the seventh highest in the OECD, at $5,500 per head in 2017—is not matched by the level of service. In theory, public hospital care is free, but waiting lists for diagnostic procedures and publicly funded specialists can stretch for months, even years. An over-reliance on expensive hospital treatment, rather than care in GP clinics, has contributed to a chronic shortage of beds. On any given day, hundreds of patients will be waiting on trolleys in hospital corridors, sometimes for more than 24 hours, hoping for a proper bed. Ireland’s minority government is well aware that, along with the acute housing shortage, health is the issue on which they are most vulnerable.

爱尔兰在医疗保健的开销相对较高 ——2017年人均5,500美元,在经济合作与开展安排里排名第七——与获得的卫生服务水平不相称。从理论上讲,公立医院的服务是免费的,但等候确诊和公共赞助专家的时刻能够继续数月,乃至数年。过度依靠贵重的医院医治而不是全科诊所,致使床位长时刻缺少。每天都有数百名患者在医院走廊里坐在手推车里等候,期望能有一个适宜的床位,有时超越24小时。爱尔兰的少数派政府清楚地知道:不仅是严峻的住宅缺少,健康也是他们最薄缺点。

Unlike their UK counterparts, some 60% of Irish people, mostly those who are not very old or very poor, have to pay up front in cash for primary health care: a single GP visit typically costs between €50 and €60 ($60-$68). The state only pays for medicines above a monthly threshold of €134.

与英国人不同,大约60%的爱尔兰人是中等收入的中年人,得预先付出现金用于初级医疗:每一次看全科诊所的话,一般要花50到60欧元(60~ 68美元)。爱尔兰每月付出的药费最低134欧元。

Junior doctors and nurses battle with long hours, stress and inadequate equipment in overcrowded and dingy old buildings. Many choose to take their training abroad. Meanwhile, a planned new National Children’s Hospital, originally billed at a hefty €650m, has seen its projected cost balloon to €1.73bn. In terms of cost per bed, an estimated €3.7m and climbing, it would be by far the most expensive hospital in the world.

一些刚入行的医师和护理在拥堵和龌龊的老旧建筑物中长时刻作业,压力大,还要面临设备缺乏的状况。许多人挑选在国外承受职业培训。与此同时,方案新建的全国儿童医院的开端投入高达6.5亿欧元,估量本钱将达17.3亿欧元。按每张床的本钱计算,估量为370万欧元且不断上升,将是迄今为止世界上出资最高的医院。

Experts blame much of the dysfunction on poor and piecemeal long-term planning, inadequate budget control and Ireland’s “two tier” public-private health system. In Ireland, unlike in most other EU countries, most specialists employed in publicly funded hospitals, already well paid by the state, are allowed to dedicate a portion of their time (typically 20%, though there is in practice little supervision) to private patients. These patients are often in the same public hospital and using publicly provided facilities. As a new EU country report noted last month, this “creates perverse incentives in publicly funded hospitals, where preferential treatment of privately insured patients adds to doctors’ private revenues”.

专家称,这个问题首要归咎于长时刻规划不善和琐细化,预算操肠胃炎-双语阅览|爱尔兰仰慕英国医疗系统却无法“复刻”控缺乏以及爱尔兰的“两级”公私医疗系统。与大多数其他欧盟国家不同,在爱尔兰,大多数在公立医院作业的专家是由国家付的高工资,并获准将用部分时刻(一般是20%,虽然实践根本没有监督)于私家患者。这些患者一般在同一公立医院并运用对大众供给的设备。正如上个月新发布的一份欧盟国家陈述所言述,这“在公立医院制作了不正当奖赏办法,对有商业稳妥的患者的供给优惠医疗服务添加医师的个人收入”。

Risn Shortall, a former junior health minister and joint leader of the centre-left Social Democrat party, notes that many worried families pay for no-frills health insurance (at an average annual cost of €1,850 in 2017), just to be able to skip lengthy queues. “Between 46% and 47% of Irish people are on private health insurance, which is by far the highest rate in Europe,” she says. Yet only 13% of the total Irish spend on health comes from private insurance, leading to the charge that the private sector is piggy-backing on the public one.

RisnShortall曾担任过初级卫生部长,是中左翼社会民主党的联合领导人。他指出,许多忧心如焚的家庭买简略医疗稳妥费(2017年的均匀年度保费为1,850欧元),仅仅为了不必排长队。 “有46%至47%的爱尔兰人运用私家医疗稳妥,是迄今为止欧洲最高的,”她说。但是,爱尔兰医疗总开销中只要13%来自私家稳妥,致使私营部分要支撑公共医疗开销的费用。

Many Irish people are familiar with and envious of the UK’s NHS and in 2017 a cross-party committee of MPs voted unanimously in favour of Slintecare (“Slinte” means “health” in Irish), a detailed plan to introduce free and improved care at all levels of treatment. One key recommendation was the phasing out of private practice in public hospitals.

许多爱尔兰人都了解并仰慕英国的NHS,并在2017年,议员的跨党委员会共同投票支撑Slintecare(“Slinte”在爱尔兰语中的意思是“健康”)——这是一个具体的方案,介绍免费和改进护理各级医治。其间一项重要主张是逐渐撤销公立医院里的个人行医行为。

The government of prime minister Leo Varadkar, himself a doctor and former health minister, has said that it accepts the plan. In practice, though, it has done little to advance it. Ms Shortall says implementing the plan would require a €7bn ring-fenced investment over ten years. The government has so far voted it only €20m.

爱尔兰总理利奥拉拉德卡尔(Leo Varadkar)自己是一名医师,曾担任过卫生部长。他表明爱尔兰政府承受上述方案。但是,在实践中,这项方案没有获得任何发展。Shortall表明,施行该方案需要在10年内投入70亿欧元的专项拨款。到目前为止,爱尔兰政府只投了2000万欧元。

Diarmaid Ferriter, a social historian at 狸猫University College Dublin, says that resistance to reform comes partly from free-market ideology (the Republic throughout its history has always been ruled by alternating centre-right parties, never left-wing ones) and partly from the insurance industry and senior doctors. “In Ireland in the 1940s private medical practitioners were worried about a reduction in their income from what they saw as “socialised medicine”, and they brought the Catholic church on board, saying that if the state extended its reach it might start looking at contraception and things like that,” he says. “The church has declined in influence, but the power of the consultants has not.”

都柏林大学(University College Dublin)社会前史学家迪亚马里费里特(Diarmaid Ferriter)表明,对医疗变革的抵抗一方面来自自由商场意识形态(爱尔兰前史上一向由替换的中右翼政党控制,而不是左翼政党),一方面来自稳妥业和资深医师。 “在20世纪40年代的爱尔兰,私家医师忧虑他们的收入从他们所谓的”社会化医疗“中削减,他们引进天主教会,宣称假如爱尔兰扩展其规模,可能会开端考虑避孕等相似的作业,”他说。“教会的影响力在下降,但医疗参谋的力气却没有。”

编译:杨健

修改:翻吧君

来历:The Economist (Mar 21st, 2019)

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