经济学人212:私人医疗保健 问题的解决者

 　　Private health care

　　私人医疗保健
　　The problem-solvers
　　问题的解决者
　　Hints of how to provide better health care for less money
　　有关花更少的钱获得更多的医疗保健的建议
　　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 1 from her days at McKinsey, a consultancy. “We've kind of figured it out,” she says.
　　CHENMED这家公司看起来和其他公司不太一样。它在迈阿密以北的一个诊所里，不仅有一个舒适的等候室，还有一个圆形的监查区。然而他们的每一个行动都是被好好设计和跟踪的。高级主管阵妮佛·托马斯。她墙上的白板上画满了图表，这是她在麦肯锡咨询公司工作时留下的习惯。“我们搞懂了这件事。”她说。
　　私人医疗保健.jpg
　　“It” is how to care for the most expensive patients in the world's most expensive health system. ChenMed is devoted 2 to poor elderly people who may have half a dozen chronic 3 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.
　　“这件事”是指如何在世界上最昂贵的医疗系统下照顾诊费最高的病人。ChenMed致力于照看那些全身都是慢性疾病的贫困老年人。只有把人照顾得好且所用医疗费用低时公司才能获利。像ChenMed这样的诊所是一个特殊的例子，不是普遍地规律。然而这家公司和其他众多的公司一样，可以为美国医疗体制更好地运行提供一些建议。
　　ChenMed is led by Christopher Chen, a doctor and the son of the company's founder 4, a Taiwanese immigrant. Other members of the Chen family hold senior positions, but they have been joined by high-flying executives and management consultants 5, lured 6 by ChenMed's model and the promise of profits as the company grows.
　　ChenMed是由台湾移民克里斯托弗·陈领导的。他是公司创始人的儿子，同时也是一名医生。陈家族的其他职员都持有高级职位，ChenMed向他们展示了公司未来的发展模型，并保证随着公司的发展，利润会不断增加。他们被此吸引，加入了该公司，成为了雄心勃勃的公司高管和管理顾问。
　　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 7 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 8 routine, with data fed back to Ms Thomas and others to find further improvements.
　　这个想法很简单。由于针对老年人的医疗保险和公共卫生计划的不断发展，越来越多的患者拿政府的钱来购买私人保险。ChenMed和那些保险公司签订合同，其中大部分为每位患者支付一个最高金额，然后为患者配备初级的护理，让他们出院。ChenMed还有专用的货车带患者往返于患者的住处和诊所，因为缺乏交通工具是阻碍老年患者就医的一个常见问题。到了诊所，患者在前台刷卡就能自动登记。员工遵循一个严格设计过的步骤，然后把数据反馈给托马斯女士和其他人，以便寻求进一步改善。
　　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 9. The clinic has a pharmacy 10, 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.
　　监察室环绕着一个中心呈圆形排列，这样医生可以方便地和助手和专家探讨问题。一个移动应用程序能让医生看到患者的医疗记录并参考临床方案。不按时吃药是患者在医院反复折腾的重要原因之一，所以，诊所配有自己的药房，医生可以直接给患者开药并回答患者提出的所有问题。大部分政府部门的精力都集中在其他地方，所以诊所的员工专注于治疗。
　　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.
　　这样做似乎很有效果。在ChenMed就医的医疗保险患者相比全国水平而言，在医院少呆了40%的时间。由于一个大保险公司胡玛纳的加入，ChenMed名下已经有两36家诊所，陈博士很乐观，他说“我们不明白我们为什么不能在未来的五年内增长300%到400%。”