风险与潜力并存 国际资本注入中国医疗行业

HONG KONG – Investing in China’s health care sector is not for the faint of heart.

香港——胆小的人不适合投资中国医疗行业。

The country’s pharmaceutical supply chain is rife with corruption. Doctors and hospital staff have been attacked and even killed by patients who have been refused treatment. Farmers unable to pay for surgical amputations have made headlines by sawing off their own limbs.

中国的药品供应链腐败横生；患者因被拒诊而袭击医生和医院工作人员；没钱进行手术截肢的农民，因为锯断自己的腿脚而登上新闻头条。

Despite all this, Chinese health care is quickly becoming one of the most popular sectors for investors looking for the next great untapped market. Foreign and local private equity groups, drug companies, hospital operators and even construction companies are pouring record amounts of money into China to invest in hospitals, clinics, pharmaceutical businesses and medical equipment manufacturers. Mergers and acquisitions in China’s health care sector rose to a record $11.3 billion in the first 11 months of this year, up 13 percent from the $10 billion in the same period a year earlier, according to Dealogic data.

尽管如此，对于寻求下一个尚未被开发的巨大市场的投资者来说，中国的医疗行业正在迅速成为最受欢迎的领域之一。国内外的私募股权机构、医药公司、医院运营商乃至建筑公司，都在将创纪录的巨额资金注入中国，投资医院、诊所、制药公司和医疗设备制造商。Dealogic的数据显示，今年前11个月，中国医疗行业的并购金额增至创纪录的113亿美元（约合700亿元人民币），较去年同期的100亿美元提高13%。

For all the challenges of China’s health care system, demand for more and better medical products and services is surging. That is because of a combination of demographics and economics: The world’s biggest populace is both rapidly aging and increasingly affluent. The consulting firm McKinsey & Company estimates that health care spending in China will grow to $1 trillion by 2020, up from just over $350 billion in 2011.

尽管中国的医疗体系面临诸多挑战，但对于更多、更好的医疗产品和服务的需求正在快速增长。这既有人口结构方面的原因，也有经济方面的原因：作为全世界人口最多的国家，中国在迅速老龄化的同时，民众也越来越富裕。咨询公司麦肯锡(McKinsey & Company)预测，到2020年，中国的医疗支出将从2011年略高于3500亿美元的水平，提高到1万亿美元。

“We’ve started noticing all sorts of players who don’t normally play in the health care space becoming very interested — they could see the demographics, the aging population,” said Mark Gilbraith, the head of PricewaterhouseCoopers’ China health care and life sciences practice, based in Shanghai. “Within China, deals are more about gaining access to untapped markets.”

“我们已经开始注意到，各类通常不涉足医疗领域的参与者，也变得很感兴趣——他们可以看到人口数据显示出的趋势，即人口老龄化，”普华永道(PricewaterhouseCoopers)驻上海的中国医疗和生命科学业务负责人马克·吉尔布雷斯(Mark Gilbraith)说。“在中国，交易所涉及的更多是获得渠道，进入未被开发的市场。”

The surge in deal making and investor interest coincides with a wave of sweeping overhauls that the Chinese government has introduced in recent years, as it tries to improve the accessibility and affordability of a health care system that has been widely described as being in a state of crisis. While recent decades brought a significant opening of the country’s economy, the reduction of socialist-style state funding left the health care system to fend for itself. The result is a half-liberalized but highly bureaucratic public hospital system that often compromises patient care in favor of profit.

交易达成的数量和投资者兴趣的激增，与中国政府近年推行的广泛改革浪潮同时出现。中国的医疗体系广泛被指处于危机状态，中国政府试图通过改革来解决看病难、看病贵的问题。尽管近几十年来，中国经济的开放程度大幅提升，但由于社会主义式的国家资助出现减少，中国医疗体系只得自谋生路。结果便造就了部分自由化、却高度官僚化的公立医院体系。这一体系常常为了获利而损害对病患的照顾。

China had 13,440 public hospitals as of October 2013, and these provided 90 percent of the country’s medical services, Xinhua, the official news agency, reported in April.

今年4月，官方通讯社新华社报道，截至2013年10月，中国有13440家公立医院，占据着中国医疗服务市场90%的份额。

“Unlike most public hospitals in the world, Chinese public hospitals are an embodiment of both government and market failures,” Winnie Yip, a professor in the Blavatnik School of Government at the University of Oxford, and William Hsiao, a professor at the Harvard School of Public Health, wrote in an article published in August in the British medical journal The Lancet.

“不同于世界上的大部分公立医院，中国的公立医院既体现了政府的失败，也体现了市场的失败，”牛津大学布拉瓦尼克政府学院(Blavatnik School of Government)的叶志敏教授(Winnie Yip)和哈佛大学公共卫生学院(Harvard School of Public Health)的萧庆伦教授(William Hsiao)在合撰的一篇文章中写道。文章于今年8月发表在英国医学期刊《柳叶刀》(The Lancet)上。

While the government limits to 15 percent the markup on drugs that hospitals can charge, doctors increase revenue by prescribing unnecessary drugs or unneeded and expensive diagnostic tests. Moreover, the professors wrote, pharmaceutical and medical equipment makers provide benefits to hospitals and physicians for using their products.

尽管政府规定，医院对药品的加价不能超过15%，但医生可以通过开不必要的药品，或是不需要的昂贵诊断检查来增加收入。此外，这两位教授还写道，制药企业和医疗设备制造商会向使用其产品的医院和医生提供好处。

As a result, by 2011, China’s spending on drugs was 43 percent of the total health expenditure, compared with an average of 16 percent in the dozens of countries with advanced economies in the Organization for Economic Cooperation and Development. At the same time, drug revenue accounted for 41 percent of total hospital revenue in China.

因此，2011年，中国在药品上的支出占到了全部医疗支出的43%，相比之下，经济合作与发展组织(Organization for Economic Cooperation and Development)数十个发达国家的平均比例为16%。与此同时，药品收入在中国医院总收入中的比重达41%。

“Many public facilities act as private entities, putting profit above patient welfare,” Professors Yip and Hsiao wrote.

“许多公立机构的行为方式与私营机构无异，把盈利置于患者的福利之上，”叶教授和萧教授写道。

The Chinese government has tried in recent years to extend basic subsidized health insurance to all its citizens and, according to official estimates, more than 90 percent of the population is covered. But the quality of this coverage varies widely across the nation, as does the ability of individuals to get access to care.

最近几年，中国政府已经设法让基本医疗保险覆盖所有居民。官方的数据显示，覆盖率已超过90%。但中国各地医疗保险的质量参差不齐，个人享受医疗服务的便利性也差异巨大。

These disparities were vividly illustrated in recent news reports, including the case of Liu Dunhe, a farmer in the southeastern Anhui Province who, uninsured and lacking the money to pay for an operation, decided to perform surgery on himself. Over the course of six hours on the night of April 20, Mr. Liu, who was suffering from severe necrosis after his feet were frostbitten, amputated his feet.

这些差异在最近的新闻报道中得到了生动的展示，比如安徽省农民刘敦和的例子。由于没有保险也没钱做手术，刘敦和决定自己动手。4月20日夜里，他在六个小时的过程中，锯掉了因为冻伤而严重坏死的双脚。

Widespread corruption in the health care system, especially involving the prescribing of drugs, is also an issue, and one that has ensnared multinational investors. In September, a Chinese court fined the British pharmaceutical giant GlaxoSmithKline nearly $500 million for bribery and jailed five of its executives, including a Briton. The government had accused Glaxo of bribing hospitals and doctors by channeling illicit kickbacks through travel agencies and drug industry associations to inflate drug prices.

医疗卫生体系普遍存在的腐败行为，尤其是涉及药品处方的腐败行为，也是一个问题。它已经让一些跨国投资者蒙受损失。9月，医药巨头葛兰素史克(GlaxoSmithKline)因行贿被中国一家法院处以近5亿美元的罚款，该公司的五名高管被判刑，包括一名英国人。官方指控葛兰素史克向医院和医生行贿，通过旅行社和制药行业协会输送回扣，提高药品价格。

China’s government is increasingly concerned about the problems of the health care system. Part of its solution has been to open the door wider to foreign investment in the sector. The latest example came in August, when the authorities expanded a pilot program begun a month earlier to allow wholly foreign-owned hospitals to operate in seven major cities and provinces. Previously, foreign ownership was capped at 70 percent.

中国政府越来越担心医疗体系的种种问题，其中一个解决办法是进一步放开该领域的外国投资。最近的例子是，今年8月，当局扩大了一个月前开始的一个试点项目，允许纯外资医院在几个主要的城市和省份经营。之前，医院的外资持股上限是70%。

A number of recent deals have followed as a result of this liberalization. In September, the American private equity giant TPG teamed with a unit of the Fosun Group, a big Chinese investment company, in a $420 million deal to privatize Chindex International, a Nasdaq-listed operator of hospitals and clinics in China and Mongolia.

这种开放措施在近期促成了多笔交易。今年9月，美国私募股权巨头德州太平洋集团(TPG)与中国大型投资公司复星集团(Fosun Group)的一家子公司合作达成了一笔4.2亿美元的交易，对纳斯达克上市的美中互利工业公司(Chindex International Inc.)实施了私有化。该公司在中国和蒙古国经营着一些医院和诊所。

More recently, UPMC, a hospital operator based in Pittsburgh, and Massachusetts General Hospital, which is affiliated with Harvard University, said they had signed or were exploring deals to manage or build hospitals in China.

不久前，匹兹堡的医院经营企业UPMC，以及哈佛大学(Harvard University)附属的马萨诸塞州综合医院(Massachusetts General Hospital)都透露，它们要么已经签约在中国管理或建设医院，要么正在寻求这方面的合作。

“Investing in China’s health sector faces many challenges,” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations in New York. He cited the large amount of capital required and the comparatively lower rates of return, as well as uncertainties over how privately owned hospitals will fit into China’s national medical care payment system.

纽约的对外关系委员会(Council on Foreign Relations)专注于全球医疗卫生的高级研究员黄延中说，“投资中国的医疗领域会遇到许多挑战。”他提到，需要付出大量资本、回报率相对较低，此外私有的医院如何纳入中国的全国性医疗支付系统也存在不确定性。

Still, he said, more private investment would benefit the entire sector, including the troubled state-funded hospitals.

他说，不过，更多私人投资会令整个行业受益，包括处境艰难的公立医院。

“Increased competitive pressures would incentivize the public hospitals to kick off more meaningful reform efforts,” Mr. Huang said. “Private investment can play an important, even critical, role in China’s health care reform.”

“竞争压力的加剧会刺激公立医院开展更有意义的改革措施，”黄延中说，“私人投资在中国的医疗改革中可以起到重要、甚至关键性的作用。”