经济学人390:亚洲私立医院 随时候命

 　　Private hospitals in Asia

　　亚洲私立医院
　　On call
　　随时候命
　　Hospital companies prepare to meet surging demand for health care in Asia
　　亚洲私立医院正准备迎接医疗需求的激增
　　A HUMID breeze wafts 1 through the wards 2 of Siloam General Hospital in Tangerang, near Jakarta. There is no air-conditioning, one of many ways the hospital contains its costs. Each room has dozens of beds arranged in neat aisles 3, privacy ostensibly offered by beige curtains. The open plan means that fewer nurses can tend to more patients. Families wait in long hallways, open to the car park.
　　位于雅加达附近文登镇的西罗亚综合医院里，一阵潮湿的微风拂过墙壁。出于医院经营成本的考虑，这里并没有空调设备。在每个房间里都有许多病床被安排在了整洁的过道当中，个人隐私表面上则由一张张米黄色帘子来保护。开放式的设计意味着少量的护士能够负责更多的患者。患者家属们在长长的走廊上等待，队列一直延伸至停车场。
　　亚洲私立医院.jpg
　　The adjoining Lippo Village hospital feels rather different. Families lounge in the lobby, sipping 4 lattes bought at the hospital's Starbucks. Pastries 5 are sold in another shop, trinkets in yet another. Health care is for sale, too. The wealthiest patients are treated in the presidential suite 6, which has not just a bed but also a sofa, a refrigerator and a flat-screen television.
　　毗邻的力宝村医院的环境则相当不一样。患者家属可以在休息室里等待，享受着医院内星巴克的拿铁。这儿有卖糕点的店铺，还有卖饰品的。同时，医疗保险也可以在这购买。最富有的病人被安排在了总统套房里，而该套房内不仅仅有一张床，还有一张沙发、一个冰箱以及一个超薄液晶平板电视。
　　Both are owned by Siloam Hospitals, an Indonesian firm. The difference is that in the General Hospital, the government pays Siloam a capped price per patient for a given condition; in Lippo Village most patients pay for themselves.
　　两家医院的拥有者都是西罗亚医疗，一家印度尼西亚公司。两家医院的区别是，在综合病院当中政府会为每一个患者在特定条件下支付特定的补贴，而在力宝村医院当中，大部分病人是自己负担治疗费用。
　　Siloam is part of a booming private business for hospital care in Asia. A bidding battle is under way for Healthscope, an Australian hospital firm which runs pathology services in Malaysia, Singapore and Vietnam. HCA of America, the world's biggest hospital firm, is reportedly prepared to pay $5 billion to outdo Fosun, a giant Chinese conglomerate 7. Last month a consortium agreed to pay $461m for Chindex, which owns a chain of hospitals in China. The group comprises Fosun, TPG Capital and Chindex's chief executive, who is married to a journalist on this newspaper.
　　西罗亚公司是冉冉上升发展的亚洲私人医疗市场的参与者之一。围绕着澳大利亚医疗企业Healthscope的竞价争夺战正在进行当中，而这是一家业务范围涵盖马来西亚、新加坡以及越南的公司。据称，世界最大的医疗企业美国HCA正筹备50亿美元以在该场收购战中胜过复星企业，后者是中国医疗业巨头之一。上个月，某财团已经同意支付4亿6100万美元来收购在中国拥有连锁医院的美中互利集团。该集团旗下拥有复星企业和德州太平洋，其CEO还与本报的一名记者结了婚。
　　The companies have every reason to smell an opportunity. Although Asia's emerging economies are slowing, the rise of their middle classes is continuing. In Indonesia the number of middle- and upper-income consumers is expected to swell 8 from 74m in 2013 to 141m by 2020, predicts the Boston Consulting Group. Rising incomes mean rising demand for health care. The average Chinese city-dweller's health spending more than doubled between 2002 and 2010, estimates PwC, a firm of consultants 9.
　　这些企业都有充分的理由去相信眼前的大好机会。虽然亚洲市场的经济增长趋缓，但中产阶级的人口比例在持续上升。波士顿咨询公司的预测显示，印尼中产及中产以上收入的消费者将从2013年的7400万人上升至2020年的1亿4100万人。持续上升的收入意味着持续上升的医疗护理服务需求。据咨询公司普华永道估计，中国城市居民平均医疗支出在2002年至2010年间增长超过了一倍。
　　Governments are trying to meet this demand. Malaysia and Thailand already have broad public health-care systems. China, which boasts that it has extended basic medical coverage 10 to 97% of its people, continues to make reforms. The Philippines is in the midst of a rapid expansion of insurance. Indonesia is in the first year of a plan to bring health coverage to the entire population by 2019.
　　政府正努力满足国家医疗需求。马来西亚和泰国已经拥有了广泛的公共医疗系统。中国声称自己的基础医疗覆盖范围达到了97%，其政府也在持续地进行医疗改革。菲律宾的医疗保险正处于快速扩张期。而对印尼来说，目前正是医疗改革的第一年，预备在2019年前完成对整个国家人口的医疗覆盖。
　　However, in many countries hospital beds are in short supply. Indonesia has only nine for every 10,000 people and the Philippines ten. America and Britain each have 29. And the quality of public hospitals varies greatly. Governments throughout the region say they will open more hospitals. But private operators think there will be a continuing shortfall for them to fill.
　　然而，许多国家的医院均出现了床位短缺的现象。在印尼，每10000人当中只有9个床位的供应量，而在菲律宾则是10个床位。美国和英国的指标则是29个床位。与此同时，公共医院的服务质量参差不齐。整个亚洲地区的政府都对外强调他们会开设更多的医院。但私人医疗机构则认为将来会有持续增长的市场空缺等待他们去填补。
　　Some companies, such as Chindex and Siloam, are concentrating on only one country. In China Phoenix 11 Healthcare Group, which made its stockmarket debut 12 in November, tripled the number of hospital beds it manages between 2010 and June last year. Deutsche Bank expects that Phoenix's revenue will grow by 20% a year between now and 2016. Siloam, which also went public in 2013, has 16 hospitals in Indonesia. By 2017 it intends to have 40.
　　部分公司只把业务集中在一个国家，如美中互利和西罗亚。去年11月上市的凤凰医疗集团，在2010年至2013年6月之间将医院床位的供应量增至三倍。德意志银行预测该集团的营业额从今年到2016年会实现20%的年均增长。同样在2013年上市，且在印尼拥有16家医院的西罗亚集团，预计到2017年将旗下医院数提升到40家。
　　Others, such as Healthscope and IHH Healthcare, a Malaysian company, have international strategies. In 2010 IHH, then owned by Malaysia's sovereign-wealth fund, bought Parkway, a Singaporean chain of high-end hospitals. In 2012 it snapped up 60% of Acibadem, a Turkish hospital firm. It went public the same year. IHH is now the largest hospital company in Asia and the second-largest in the world by market value. Its business stretches from Abu Dhabi to Vietnam. At Parkway's newest hospital in Singapore, the muted wall colours evoke 13 a hotel; a special scent 14 is piped in to mask antiseptic odours. “Universal coverage is no-frills coverage,” explains Tan See Leng, IHH's chief executive. “We offer the frills.”
　　另外一部分公司则拥有全球发展战略，如Healthscope和马来西亚的综合保健控股（IHH Healthcare）。在2010年，由马来西亚主权财富基金所拥有IHH收购了新加坡高端连锁医院Parkway，在2012年则买下了土耳其医疗集团Acibadem高达60%的股权。2012年同年IHH正式上市。以市场价值来计算，IHH目前是亚洲最大、世界第二大的医疗集团，其业务范围从阿布达比市延伸至越南。Parkway公司在新加坡最新建立的医院里，柔和的墙面色彩让人感受到了酒店的氛围；特殊的香味持续地输入室内以缓和消毒药剂的气味。IHH首席执行官Tan See Leng解释道：“全民覆盖的医疗服务只是没有任何附加的基础服务，而我们会提供更多。”
　　However, at least three obstacles lie in the path of Asia's ambitious private hospital companies. The first is simply that doctors and nurses are scarce. Companies in China have trouble attracting doctors from public hospitals, which offer good pay and pensions. Indonesia's rules for foreign doctors all but prohibit hospitals from recruiting them.
　　然而，目前至少有三大问题阻碍着雄心勃勃的亚洲医疗企业。首先，简单地说就是医生和护士的短缺。由于薪水和养老金方面的原因，中国的私立医院无法从公立医院里吸引医生过来。印尼对外国医生的管理仅有一条，那就是禁止医院聘请外国医生。
　　Second, regulations can be treacherous 15. Gershu Paul, a former boss of Siloam, says that the time needed to obtain licences, permits and so on constrains 16 growth. The rules sometimes stop companies investing at all. In 2012 Hong Kong's government requested bids to build two new hospitals. IHH and its local partners, which agreed to stipulations covering everything from the number of obstetric beds to the share of local patients, last year won the right to build one site. For the other site there was only one bid—which was rejected because it did not meet the government's requirements.
　　其次，行业法规或许是不安的因素。西罗亚的前任老板Gershu Paul表示，申请营业执照、营业许可等等的一些条件都限制了医疗市场的增长。有时，一些条款完全让私人公司无法进行投资。2012年，香港政府为建立两所新医院发起了招标项目，而去年IHH和本地合伙人赢得了其中一所的承包权。他们答应了政府要求的从产科病床数到本地病人分享机制的所有条款。对于另外一所医院，在只有一家竞标商的情况下仍因为不满足政府要求而被拒绝。
　　The third obstacle is uncertainty 17. Selling to the swelling 18 middle class is no doddle: in such a new market, firms are finding it hard to gauge 19 what people will pay for, say, a hip 20 operation, or whether they will pay more for their aged 21 parents' care or for their children's. Siloam's private hospitals have six price tiers, an attempt to serve the many segments of Indonesia's dynamic market, yet last year only 51% of their beds were filled. So far, the rich are the most dependable moneymakers. When IHH considers entering a market, it notes a country's Gini coefficient, a measure of inequality: higher inequality implies wealthier patients willing to pay for treatment.
　　最后一个问题是市场的不确定性。要在持续增长的中产阶级市场中取得成绩绝非易事：在这样的新市场里，医疗公司难以估测人们会为哪个项目买单，例如髋部手术，或者人们是否会为他们年迈的双亲和孩子支付更高价格的医疗服务。西罗亚的私立医院将医疗服务分六个层次来定价，以尽可能多地囊括印尼多变的医疗市场。然而，去年该医院的床位仅达到了51%的使用率。到目前为止，富裕阶层是最可靠的盈利来源。当IHH公司考虑进入一个市场时，它会去关注国家的基尼系数：更高的贫富差距，意味着富裕的病人更愿意为高质量高价格的医疗服务买单。
　　Eventually some firms may prove adept 22 at offering good, cheap treatment. Narayana Health, an Indian company, has tried to industrialise hospital operations to make care less pricey. But it remains 23 to be seen how many private hospitals will count public-health services among their customers. In China, Phoenix has tested schemes in which the government pays it to run public hospitals. The government has said that public insurance may be used for private care, but implementation 24 has been patchy. Of the 40 hospitals in Siloam's plan for 2017, only the General in Tangerang will take fees from the government. Hospital companies will surely be part of Asia's emerging health-care systems. How big a part is much less certain.
　　最终部分公司或许能在优质廉价的医疗服务领域如鱼得水。一家印度公司Narayana Health已经开始尝试将医院手术工业化，以降低医疗服务的价格。然而，会有多少私立医院将公共医疗服务作为自己的业务内容仍是个未知数。在中国，凤凰医疗集团已经着手进行了实验：政府支付给私人公司去运营公立医院。政府已经表示了公共医疗保险或许也能用于私人医疗服务，但该项目的实施困难重重。截至2017年为止的西罗亚公司40家医院里，只有文登镇的综合医院会收取政府的费用。可以肯定的是，医疗企业会参与到亚洲新兴的医疗系统当中来，而其规模有多大则无法确定。