睁眼看世界: 中国忙医保,国外看热闹

Aging populations, longer life spans and ever-higher expectations of quality of life are placing burdens on public health-care systems across Asia. At first this sounds similar to the challenges facing policy makers in Western countries, but there is a critical difference. While leaders in the U.S. and Europe struggle to adapt existing but inefficient health-care systems to changing circumstances, many Asian governments have the opportunity to build from scratch. As they do so, they should be alert to ways the private sector can help.

日趋老龄化的人口、更长的寿命以及对生活质量越来越高的期望正在给亚洲各地的公共医疗卫生系统带来压力。这种情况乍听起来跟西方国家决策者面临的挑战相似，但其中存在一个重大差别。美国和欧洲的领导人正在艰难地对现行效率低下的医疗系统进行调整，使之适应变化的形势，而许多亚洲国家政府则有机会从头开始打造医疗系统。而在构建这个系统的时候，他们应当留心私营部门能够在哪些方面提供帮助。

According to the United Nations, the number of Asians older than age 65 will soar to 857 million in 2050 from 207 million in 2000. As a result, the dependency ratio is projected to rise sharply, to 27.8 young or elderly dependents per 100 people in 2050 from 9.1 dependents per 100 people in 2000. An ever-greater proportion of resources will shift toward health care. While the U.S. economy devotes roughly 18% of its annual output on health care, in China that number is only 5% and in Indonesia 3%.

联合国数据显示，2050年亚洲65岁以上老人的数量将飙升至8.57亿人，2000年为2.07亿人。如此一来，抚养比率预计将会大幅上升，从2000年的每百人负担9.1名年轻和年老的被抚养者，上升到2050年的每百人负担27.8名被抚养者。越来越多的资源将被用于医疗保健。美国经济年产出的大约18%被用于医疗保健，而中国和印尼的这一比例则分别仅为5%和3%。

Policy makers must tread carefully, however. Higher spending alone could skew incentives and permanently cripple government balance sheets. The focus must be not only on expanding access to care, but building a sustainable financing model from the start.

不过，决策者必须谨慎行动。单是支出的增加就可能造成动机的扭曲，并且永久性地削弱政府的资产负责表。决策者关注的焦点必须不仅是扩大获得医疗保健服务的渠道，而且要从一开始就建立一个可持续的融资模式。

A first step should be to recognize that the private sector, including foreign companies, can offer valuable expertise. Through the aggregate decisions of millions of customers, commercial entities are acutely aware of consumer needs and demands. Furthermore, the global reach of international players offers a broader perspective of how different solutions can apply to various policy goals.

第一步是要意识到，包括外企在内的私营部门可以提供有价值的专业知识。通过积累数百万客户的反馈，这些商业实体能够准确地意识到用户的需要和诉求。此外，跨国公司的全球影响力提供了更广阔的视角，可以帮助我们了解不同的解决方案是如何用于不同的政策目标的。

Such collaboration already is bearing fruit. The Hong Kong government, in its consultation on healthcare reform in 2008, solicited input from the private sector in such areas as enhancing primary care and reform of health-care financing. The insight, expertise and data private insurers and others were able to provide proved valuable for policy makers.

这样的合作已经产生效果。香港政府2008年为医疗保健改革征求意见时，征集了私营部门有关加强基础护理以及医疗保健融资改革等领域的想法。私营保险公司以及其他机构提供的见解、专业知识和数据对决策者极具价值。

Private insurers, both domestic and foreign, also can play a useful role in implementing solutions. Over the last 10 years China has made great strides in its health-care provision, enrolling 900 million people in various public schemes to ensure coverage of more than 95% of Chinese citizens. However, current coverage is patchy, leading to a lack of confidence among consumers and fears of high costs.

国内外的私营保险公司在落实解决方案的过程中也能扮演有用的角色。过去10年，中国在医疗保健的储备方面实现了较大的跨越，在各种公共计划中纳入了9亿人，确保覆盖范围超过95%的中国公民。不过，目前的覆盖并不均衡，这打击了消费者信心，引发了对高医疗成本的担忧。

Beijing says it will rely on private insurers to fill the gap beyond basic coverage. Already local governments in Fujian province and Chongqing allow private insurers to manage public schemes. The industry has grown 27% annually over the past 10 years.

中国政府表示，将依赖私营保险商填补基本覆盖之外的缺口。福建省和重庆的地方政府已经允许私营保险公司管理公共项目。这一产业过去10年平均每年增长了27%。

In this regard, Singapore's ElderShield Plan, started in 2002, provides a particularly good example for others to follow. The government developed the scheme in consultation with the insurance industry, and works by allowing citizens to select coverage from a slate of approved plans. Since then, the government has worked with its private partners to review and improve the service through additional public consultation and surveys from users, resulting in adaptable, more cost effective coverage.

在这方面，新加坡于2002年开始的乐龄健保计划(ElderShield Plan)提供了一个可以效仿的良好范例。政府与保险行业磋商制定了该计划，并让民众从一系列得到认可的计划中选择保险类别。在那之后，政府一直与私营合作伙伴一起通过额外的公共咨询和用户调查不断审查和改进这项服务，从而打造出适应性强、最具成本效益的保险类别。

However, the mechanics of designing a new health program are only part of the challenge. Policy makers must also be alert to several other necessary components of health-care sustainability. Education is the most important.

然而，设计新的医疗保健计划的技术细节只是挑战之一。决策者们还必须留意医疗可持续性的其他几个必要元素。其中最重要的就是教育。

First, educated consumers are likely to make wiser choices. Singaporeans are encouraged, through public health education programs, to adopt healthy lifestyles and be responsible for their own health. Evidence-based health screening has been introduced for the early detection of common ailments, such as cancer, heart disease, hypertension and diabetes mellitus.

首先，受过教育的消费者可能做出更明智的选择。新加坡的公共卫生教育项目鼓励新加坡人采用健康的生活方式，为自己的健康负责。循证健康筛查已被用于常见病的早期诊断，如癌症、心脏病、高血压和糖尿病等。

Alongside this is the importance of policy education building an understanding within government of the long-term needs of the public. Laying the foundations for consensus in this regard is important for lasting change. Singapore initiated its reforms based on the findings of two foundational reports from the Ministry of Health. These helped explore the issues at play and recommended the involvement of private insurers, building support for the solution within government.

政策教育同样重要，即加强政府内部对于公众长期需求的了解。在这方面打下共识的基础对于保障变革的持续性而言非常重要。新加坡启动改革的依据是其卫生部两个基础性报告的结果。这两份报告考察了相关的问题，并建议让私营保险公司参与进来，为政府内部的解决方案提供支持。

Finally, policy makers need to ensure that financing solutions are as inclusive as possible right from the beginning. Studies show that shifting responsibility for financing onto the private sector does tend to favor the middle class and wealthy who can afford more care. Any program must provide satisfactory minimum levels of coverage not least to maintain political support for such systems.

最后，决策者还需要确保融资解决方案从一开始就尽可能地包括所有费用。研究发现，将融资责任转到私营部门往往对负担得起更多医护开支的中产阶级和富人更有利。任何医疗项目都必须提供令人满意的最低覆盖水平，不仅仅是为了保证这类体系能获得政治支持。

Furthermore, lower-income consumers need to be made aware of the options available to them, ideally through coordinated outreach efforts by governments and private insurers. In Malaysia, the industry-backed Insurance Info Programme since 2003 has provided easy-to-understand materials, online resources and financial education in schools to promote financial inclusion. Such schemes must use multiple channels to engage the broadest possible audience.

此外，需要让收入较低的消费者了解他们可以有哪些选择，最好是通过政府和私营保险公司协调进行的沟通措施来实现。在马来西亚，从2003年开始、由保险行业提供支持的保险信息项目(Insurance Info Programme)提供了易于理解的材料、网络资源以及在校金融教育，以提高金融包容性。这类方案必须利用多种渠道，最大限度地让人们了解。

Sustained by its high growth rates, Asia has time yet before the cost of health and aged care becomes an overwhelming force and threatens a Eurozone-style crisis. Governments across Asia should use this grace period to devise health-care public-private partnerships that actually work for their citizens. With the unrelenting demographic forces at play, time may be shorter than they think.

凭借高速经济增长，在公共卫生和老年人护理的成本变得难以承受、造成欧洲式危机之前，亚洲还有时间。亚洲各国政府应当利用这个“宽限期”，设计出政府与私营部门合作的医疗保健项目，使之真正有利于民众。在人口因素的无情作用下，这个宽限期可能比他们想象的要短。