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过度医疗何其多

Too Much Medical Care?
过度医疗何其多

A few years ago, my daughter sprained her ankle at dance camp. What happened next offers a glimpse into some of the problems in our nation's health care system.

几年前,我的女儿在舞蹈训练营里扭伤了脚踝。接下来发生的事情,让我们得以瞥见这个国家医疗体系中的一些问题。

For years, we've been hearing that the United States spends more on health care than any other country, even as it lags far behind other countries in terms of quality of care.

多年来,大家一直听闻,美国在医疗上投入的经费比其他任何国家都要多,不过在提供的医护服务质量方面,却落后于不少国家。

The numbers are staggering. Health spending in the United States neared $2.6 trillion in 2010 - that's 10 times the $256 billion spent in 1980. The Institute of Medicine estimates that in 2009, the most recent year for which data are available, the country spent about $210 billion on unnecessary medical services.

相关数字让人惊愕不已。在2010年,美国在医疗上投入了将近2.6万亿美元,是1980年2560亿美元的10倍。美国医学研究所(The Institute of Medicine)预计,在2009年(这是有数据可查的最近的年份),美国在不必要的医疗服务上就花费了2100亿美元左右。

Broken down, this means that the United States spends about $8,000 per person annually on health care - that's about 50 percent more than Norway and Switzerland. In the United States, hospital stays are far more expensive than those in other countries, averaging about $18,000 per discharge, compared with less than $10,000 in Sweden, Australia, New Zealand, France and Germany.

平均算下来,美国每年在每个人身上投入了8000美元左右的医疗费用——这比挪威和瑞士高出了50%左右。在美国,住院费比其他不少国家都更昂贵,平均每人次花费为1.8万美元左右,相比之下,瑞典、澳大利亚、新西兰、法国和德国的同类花费为不到1万美元。

But what do these numbers really mean to the average patient? What's going on in the doctor's offices and hospitals around the country to create such bloated spending?

但这些数字对于普通病患来说究竟意味着什么呢?在遍及美国各地的诊所与医院里究竟发生了什么,能创造出如此庞大的花费?

That's where my daughter's ankle comes in. At the time, the injury seemed unremarkable. Her pediatrician suggested waiting it out, but after a month with no improvement, I sought a second opinion from a sports medicine specialist, who ordered an M.R.I., but ended up referring her to a pediatric orthopedic surgeon.

这就是我女儿脚踝受伤后发生的事情。起初她的伤看起来并不严重,她的儿科医生建议观察,但过了一个月,伤情还是没有好转,于是我找到了一位运动医学专家,征求第二方建议,这位专家让我女儿接受核磁共振检查(M.R.I),后来又转介她去看儿科整形外科医生。

The specialist examined the ankle and ordered another M.R.I. as well as extensive blood work. After seven vials of blood, my daughter nearly passed out.

专家又检查了我女儿的脚踝,又一次让她接受核磁共振检查,同时进行了更多血检。在抽了七管血后,我女儿差点就晕倒了。

A week later the doctor called. Some of the blood work looked uncertain, and he wanted to retest. After several more vials of blood, the results remained ambiguous. Even so, my daughter was referred to an eye specialist and a pediatric rheumatologist, who ordered more blood work and a third M.R.I. At the end of the appointment, the doctor noticed my daughter's crooked pinkie fingers and, oddly, ordered an X-ray of her hands. Five months after twisting an ankle, my otherwise healthy daughter limped out of the radiology office carrying X-rays of her hands. "Mom,'' she said, "my ankle still hurts."

一个星期后,医生打来电话,告诉我一些血检的结果看起来有些模棱两可,希望重做检查。我的女儿又被抽了好几管血,可检查结果仍然很含糊。尽管如此,医生还是进而转介我们去看眼科专家和儿科风湿病专家,而他们又让我女儿做了更多血检,并且接受了第三次核磁共振检查。在这次看病快结束时,医生注意到我女儿两手的小指头有点弯,于是又开了张很奇怪的检查单,让她两只手照张X光片。于是,在我女儿扭伤了脚踝五个月后,双手却被照了X光,然后一瘸一拐地走出了放射科检查室,这个在其他方面都很健康的孩子对我说:“妈妈,可是我的脚踝还在痛啊。”

After years of reporting on health, I considered myself a well-informed patient, but it took my elementary-school daughter to state the obvious: She was the victim of too much medicine. Every new blood test, scan or X-ray raised new questions, which led to more lab work, scans and X-rays. I know the doctors had good intentions, but it's a truism of modern medicine that the more you test and scan and look for problems, the more likely you are to find something wrong. My daughter's case had spiraled out of control.

我从事了多年健康新闻报道,自认为是个见多识广的患者,但这一次,道出事实的却是我读小学的女儿:她是过度医疗的受害者。每次新的血检、扫描或X光检查都制造了新问题,引发了更多血检、扫描和X光检查。我知道这些医生都是出于善意,但现代医学确实存在着这样一条不言自明的真理,那就是你做的检查越多,越想要通过检查找到问题,就越有可能发现你身体真的有什么地方不对劲。我女儿的看病过程就是这样螺旋式发展,直到最后完全失去控制。

I canceled all her appointments with the various specialists, and went back to the sports doctor. We discussed a new approach that focused solely on pain relief. He consulted with my daughter's pediatrician, and they agreed on a treatment. Within days, my daughter's ankle had stopped throbbing, and soon she was back to sports and dancing. The cost of this ankle injury had reached well into the thousands of dollars - I had lost track because it was all covered by my insurance.

我取消了与各位专家的看诊时间,重新回去找那个运动医学医生,一起讨论了一个解决她问题的新办法,把焦点放在止痛上。他咨询了我女儿的儿科医生的意见,制定出了一个统一的治疗方案。没过几天,女儿就感觉脚踝不再阵痛了,很快她就重新开始运动、跳舞。她脚踝受了一次伤,治疗费用达到了好几千美元——所有费用都由我的保险公司承担,所以最后具体是多少我并不清楚。

Solving the problem of excessive health care spending, while finding ways to offer better care to those without insurance, is arguably one of the most pressing issues facing our country. Over the coming weeks, I want to explore the reasons behind our troubled health care system from the perspective of the patient. Along the way, I'll check in with various experts, from physicians on the front lines to policy experts searching for solutions, who can add their own insights to the discussion.

在解决过度医疗的同时,又能为那些没有保险的人提供更好的医疗服务,这可能是美国目前最严峻的课题之一。在接下来的几星期里,我想从病人的角度来剖析我们的医疗保健体系究竟为什么会出现诸多问题。在此期间,我还会拜访从医疗第一线的医生到政策专家的各位人士,相信他们也会提供各自的真知卓见,力求一起来为这些棘手的问题提供解决之道。

The goal will be to shed light on both the good and the bad in the American health care system and help set the health care agenda for the next president. The series will be part of a larger New York Times project called The Agenda, which will focus on some of the most critical issues that the president and the next Congress will face in the coming months and years.

我们的目标是要厘清美国医疗保健体系中存在的优点和弊端,帮助下一任总统建立一个医疗保健议程。这个系列报道是《纽约时报》一个大型报道项目“议程”(The Agenda)中的部分内容,报道旨在关注总统和下一届国会在未来几个月到几年将要面对的一些最为重大的话题。

Excess Healthcare Spending

过度医疗花费


Unnecessary Services = $210 billion

不必要的医疗服务=2100亿美元

Inefficiently Delivered Services = 130 billion

低效医疗服务=1300亿美元

Excess Administrative Costs = 190 billion

冗余行政经费=1300亿美元

Prices that are Too High = 105 billion

过高收费=1050亿美元

Missed Prevention Opportunities = 55 billion

错失预防时机=550亿美元

Fraud = $75 billion

骗保=750亿美元
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