是什么让美国的医疗体系如此昂贵?
正文翻译
What makes the US healthcare system so expensive?
是什么让美国的医疗体系如此昂贵?
What makes the US healthcare system so expensive?
是什么让美国的医疗体系如此昂贵?
评论翻译
David Chan
Why is healthcare in the United States so expensive when compared to other countries which provide treatment of comparable or better quality?
There is a long list of reasons but here's a start.
美国的医疗费用为何远高于其他国家，尤其是考虑到其他国家提供的医疗服务质量相当甚至更好？这里有很多原因，以下是一些主要的解释：
Why is healthcare in the United States so expensive when compared to other countries which provide treatment of comparable or better quality?
There is a long list of reasons but here's a start.
美国的医疗费用为何远高于其他国家，尤其是考虑到其他国家提供的医疗服务质量相当甚至更好？这里有很多原因，以下是一些主要的解释：
1. Americans won't permit or accept healthcare rationing. America spends much more for care in the last 6 months of life than any other country. By a lot.
Walk through any ICU and you'll routinely see some people in vegetative conditions with virtually no chance of getting better. Yet they are receiving a full court press with anything and everything that can be done from the standpoint of medical technology.
美国人通常不接受医疗服务的配给制度。美国人在生命最后6个月的医疗费用比其他任何国家都要高,高出好多。
走过任何一个重症监护室，你都会经常看到一些人处于植物人状态，几乎没有好转的机会，但他们仍然在接受医疗技术所允许的一切手段，进行全面而竭尽全力的治疗。
Walk through any ICU and you'll routinely see some people in vegetative conditions with virtually no chance of getting better. Yet they are receiving a full court press with anything and everything that can be done from the standpoint of medical technology.
美国人通常不接受医疗服务的配给制度。美国人在生命最后6个月的医疗费用比其他任何国家都要高,高出好多。
走过任何一个重症监护室，你都会经常看到一些人处于植物人状态，几乎没有好转的机会，但他们仍然在接受医疗技术所允许的一切手段，进行全面而竭尽全力的治疗。
Some of the push for this care comes from families who are adamant against witholding or withdrawing care. But doctors are also guilty of over-treatment. We all know some crazy doctors who believe that miracles can happen daily in the ICU regardless of how hopeless the situation may be.
这种对治疗的坚持部分源自那些坚决反对减少或停止治疗的家庭成员。同时，医生们也难辞其咎，他们有时会过度治疗。我们都听说过一些医生，他们坚信在重症监护室里，不管情况多么绝望，总有奇迹发生。
这种对治疗的坚持部分源自那些坚决反对减少或停止治疗的家庭成员。同时，医生们也难辞其咎，他们有时会过度治疗。我们都听说过一些医生，他们坚信在重症监护室里，不管情况多么绝望，总有奇迹发生。
The expense is enormous and American families are divorced from it. If the patient is uninsured, the costs are absorbed by the treating hospital and the doctors. If the patient is insured, the deductible has been met and the rest is paid for by insurance or via the taxpayers .
这笔开销极为庞大，美国家庭却往往与之脱节。若患者未投保，相关费用便由治疗医院和医生承担。若患者已投保，一旦满足了免赔额，剩余费用便由保险公司承担，或者通过纳税人资金支付。
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这笔开销极为庞大，美国家庭却往往与之脱节。若患者未投保，相关费用便由治疗医院和医生承担。若患者已投保，一旦满足了免赔额，剩余费用便由保险公司承担，或者通过纳税人资金支付。
原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处
You won't see this in any other country with a national health service. Elderly patients don't get started on dialysis in the NHS in England. They die of kidney failure. You won't see 75 or 80 year olds getting quadruple bypass surgery either. Cancer patients in Canada and England routinely don't get $10,000 a month drugs for cancer treatment that prolongs life by several months (on average). The drugs either aren't available at all like in Canada (where some cancer drugs never get approved), or they are made virtually unavailable through a lottery in England.
在其他国家的国家卫生服务体系中，你不会见到这样的做法。例如，在英国的国家卫生服务（NHS）中，老年患者通常不会开始接受透析治疗，而是会因肾功能衰竭而去世。同样，你也不会看到七八十岁的老人接受四重搭桥手术。在加拿大和英国，癌症患者通常无法获得每月高达1万美元、平均只能延长几个月生命的昂贵抗癌药物。这些药物在加拿大可能根本无从获得（因为有些抗癌药物从未获得批准），或者在英国，它们通过一种抽签制度几乎变得不可及。
在其他国家的国家卫生服务体系中，你不会见到这样的做法。例如，在英国的国家卫生服务（NHS）中，老年患者通常不会开始接受透析治疗，而是会因肾功能衰竭而去世。同样，你也不会看到七八十岁的老人接受四重搭桥手术。在加拿大和英国，癌症患者通常无法获得每月高达1万美元、平均只能延长几个月生命的昂贵抗癌药物。这些药物在加拿大可能根本无从获得（因为有些抗癌药物从未获得批准），或者在英国，它们通过一种抽签制度几乎变得不可及。
2. Americans pay much more for pharmaceuticals than anyone else in the world. The American government, under pressure from the Big Pharma lobby, refuses to negotiate discount rates for Medicare. So Americans pay 30% to 300% more than Canadians for the identical drug made in New Jersey or California.
美国在药品上的花费远高于世界其他国家。在美国政府受到大型制药业游说团体的影响下，拒绝为联邦医疗保险（Medicare）提供折扣价格谈判。因此，美国人为同样的药物支付的费用比加拿大人高出30%至300%——尽管这些药物可能是在新泽西或加利福尼亚制造的。
美国在药品上的花费远高于世界其他国家。在美国政府受到大型制药业游说团体的影响下，拒绝为联邦医疗保险（Medicare）提供折扣价格谈判。因此，美国人为同样的药物支付的费用比加拿大人高出30%至300%——尽管这些药物可能是在新泽西或加利福尼亚制造的。
3. There is gigantic waste and fraud in Medicaid and Medicare programs. Billing is electronic and payment is automatic. Auditing is very expensive and apparently very rarely occurs. It's so lucrative and easy to skim hundreds of millions of dollars per scheme that organized crime is now involved.
在美国联邦医疗保险（Medicare）和 联邦医疗补助（Medicaid）项目中，存在着巨大的浪费和欺诈问题。账单是电子化的，支付是自动完成的。审计过程不仅成本高昂，而且显然很少执行。由于通过欺诈手段从这些计划中骗取数亿美元的收益巨大且操作简单，现在连有组织的犯罪集团也参与其中。
在美国联邦医疗保险（Medicare）和 联邦医疗补助（Medicaid）项目中，存在着巨大的浪费和欺诈问题。账单是电子化的，支付是自动完成的。审计过程不仅成本高昂，而且显然很少执行。由于通过欺诈手段从这些计划中骗取数亿美元的收益巨大且操作简单，现在连有组织的犯罪集团也参与其中。
There are reasonable estimates that the fraud is $120-$180 billion a year. This are astronomic numbers.
据合理估算，每年的欺诈金额在1200亿到1800亿美元之间，这是一个天文数字。
据合理估算，每年的欺诈金额在1200亿到1800亿美元之间，这是一个天文数字。
Comments are frequently made about how efficient Medicare and Medicaid are because they have such low administrative costs compared to insurance companies. (It's pretty difficult to scam insurance companies for large amounts of money.) But the administration of Medicare/Medicaid includes the Department of HHS and also various law enforcement arms of the federal government. That's not cheap. And it's apparently not very effective either.
人们经常称赞联邦医疗保险（Medicare）和 联邦医疗补助（Medicaid）的效率，因为与保险公司相比，它们的行政成本要低得多。（要从保险公司那里骗取大量资金相当困难。）但是，Medicare/Medicare的行政管理不仅涉及卫生及公共服务部（HHS），还包括联邦政府的多个执法机构。这并不便宜，而且显然效果也不尽人意。
人们经常称赞联邦医疗保险（Medicare）和 联邦医疗补助（Medicaid）的效率，因为与保险公司相比，它们的行政成本要低得多。（要从保险公司那里骗取大量资金相当困难。）但是，Medicare/Medicare的行政管理不仅涉及卫生及公共服务部（HHS），还包括联邦政府的多个执法机构。这并不便宜，而且显然效果也不尽人意。
4. Americans demand immediate access to technology. We want the ability to get an MRI tomorrow or that latest diagnostic test and treatment reported on CNN. That kind of access is incredibly expensive both in overhead — to build the facilities and purchase the machines — let alone the costs of the procedures.
美国民众期望能够即刻获得技术资源。他们希望能够迅速预约到磁共振成像，或者是在美国有线电视新闻网上看到的最新诊断测试和治疗方法。这种即时获取技术的能力，其代价极为昂贵，不仅包括建设医疗设施和购置昂贵设备的成本，还有执行这些程序所需的费用。
美国民众期望能够即刻获得技术资源。他们希望能够迅速预约到磁共振成像，或者是在美国有线电视新闻网上看到的最新诊断测试和治疗方法。这种即时获取技术的能力，其代价极为昂贵，不仅包括建设医疗设施和购置昂贵设备的成本，还有执行这些程序所需的费用。
We Americans want these tests sometimes, even when they are considered not necessary for good health. We ask our doctors to rule out the 1 in 10,000 event. It's human nature to want the latest and greatest of everything. But its never free and this kind of medical care costs a tremendous amount of money.
即使有时候这些检查对于维持健康并非必要，美国人仍然希望进行这些检查。我们请求医生排除那些极小概率的事件。追求最新最好的一切是人类的本能。但它从来不是免费的，这种医疗服务需要花费大量的钱。
即使有时候这些检查对于维持健康并非必要，美国人仍然希望进行这些检查。我们请求医生排除那些极小概率的事件。追求最新最好的一切是人类的本能。但它从来不是免费的，这种医疗服务需要花费大量的钱。
5. The wasteful practice of defensive medicine. In America there are enormous numbers of unnecessary tests and scans that are performed by a doctor to cover his/her ass just in case of a lawsuit. It's impossible to practice in America without facing the threat of litigation. I, and every doctor answering honestly, will admit to ordering defensive tests.
I've seen estimates of $600+ billion a year in unneeded tests and procedures done primarily to avoid litigation. That's a lot of money that could otherwise go to insuring the uninsured. Opponents to tort reform quote very small numbers because they only use the cost of defending lawsuits in their equation. But that's a drop in the bucket compared to what doctors in America waste so that no one will accuse them of "missing something."
美国存在一种防御性医疗的浪费做法。医生们为了避免可能的诉讼，会进行大量不必要的检测和扫描，这种做法造成了巨大的资源浪费。在美国，医生在执业时无法忽视诉讼的威胁，我以及每一位坦率的医生都会承认曾经开具过出于防御目的的检查单。
我见过估算显示，每年因不必要的检测和手术而浪费的金额超过6000亿美元，这些检测和手术主要是出于避免诉讼的考虑。这笔巨额资金本可以用于为未投保人群提供医疗保险。反对医疗事故改革的人在他们的论据中只提到了很小的数字，因为他们仅考虑了应对诉讼的费用。然而，与美国医生为了避免被控告“漏诊”而浪费的资金相比，这仅仅是沧海一粟。
I've seen estimates of $600+ billion a year in unneeded tests and procedures done primarily to avoid litigation. That's a lot of money that could otherwise go to insuring the uninsured. Opponents to tort reform quote very small numbers because they only use the cost of defending lawsuits in their equation. But that's a drop in the bucket compared to what doctors in America waste so that no one will accuse them of "missing something."
美国存在一种防御性医疗的浪费做法。医生们为了避免可能的诉讼，会进行大量不必要的检测和扫描，这种做法造成了巨大的资源浪费。在美国，医生在执业时无法忽视诉讼的威胁，我以及每一位坦率的医生都会承认曾经开具过出于防御目的的检查单。
我见过估算显示，每年因不必要的检测和手术而浪费的金额超过6000亿美元，这些检测和手术主要是出于避免诉讼的考虑。这笔巨额资金本可以用于为未投保人群提供医疗保险。反对医疗事故改革的人在他们的论据中只提到了很小的数字，因为他们仅考虑了应对诉讼的费用。然而，与美国医生为了避免被控告“漏诊”而浪费的资金相比，这仅仅是沧海一粟。
6. Regulation and certification. The regulatory process in America has become so burdensome for hospitals, clinics and physicians that to meet compliance standards, a small army of administrators and attorneys are needed to go through them. After the ACA was implemented, many doctors had to join healthcare systems to navigate them. Over the past 10 years, our clinic administrative staff more than doubled. Similarly the hospital administrative staff have increased as well to meet regulatory requirements and pass the various inspections that accompany them. There are numerous fees and licenses involved in medical care today. There is a financial cost to this that gets passed on to insurance payers.
监管和认证。
对于医院、诊所和医生来说，美国的监管程序已经变得如此繁重，以至于为了达到合规标准，需要一小群管理人员和律师来通过这些程序。《平价医疗法案》实施之后，为了适应新的规章制度，许多医生选择加入了大型医疗系统。在过去十年里，我们诊所的行政管理人员数量翻了不止一番。医院同样扩充了行政团队，以确保符合各项规定并通过必要的各项检查。医疗行业如今需要处理大量的费用和许可证问题。这些相关的财务开销最终会转嫁到保险公司，由它们支付。
监管和认证。
对于医院、诊所和医生来说，美国的监管程序已经变得如此繁重，以至于为了达到合规标准，需要一小群管理人员和律师来通过这些程序。《平价医疗法案》实施之后，为了适应新的规章制度，许多医生选择加入了大型医疗系统。在过去十年里，我们诊所的行政管理人员数量翻了不止一番。医院同样扩充了行政团队，以确保符合各项规定并通过必要的各项检查。医疗行业如今需要处理大量的费用和许可证问题。这些相关的财务开销最终会转嫁到保险公司，由它们支付。
Glyn Williams
I notice that you don't explain why for a given simple procedure, an American hospital might charge 10X more than the same procedure in the UK.
我注意到你没有解释为什么在美国，相同简单的医疗程序，医院的收费可能是英国的10倍。
原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处
I notice that you don't explain why for a given simple procedure, an American hospital might charge 10X more than the same procedure in the UK.
我注意到你没有解释为什么在美国，相同简单的医疗程序，医院的收费可能是英国的10倍。
原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处
Ben Levy
An American hospital, for a simple procedure, might charge 40x more than the same procedure done in another hospital in the US. 10X is nothing.
The costing and billing procedures used here are insane.
Data Reveal Hospital Charges Vary Widely for Same Procedure
在美国，即使是简单的医疗程序，一个医院的收费可能比美国国内其他医院高出40倍。相比之下，10倍根本不算什么。这里的成本计算和账单程序简直荒谬。数据显示，即便是同一医疗程序，不同医院的收费也存在巨大差异。
原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处
An American hospital, for a simple procedure, might charge 40x more than the same procedure done in another hospital in the US. 10X is nothing.
The costing and billing procedures used here are insane.
Data Reveal Hospital Charges Vary Widely for Same Procedure
在美国，即使是简单的医疗程序，一个医院的收费可能比美国国内其他医院高出40倍。相比之下，10倍根本不算什么。这里的成本计算和账单程序简直荒谬。数据显示，即便是同一医疗程序，不同医院的收费也存在巨大差异。
原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处
Chris Baer
I believe this is largely driven by using people who can pay to subsidize people who cannot pay.
In the US, hospitals are required to treat all patients in the emergency department regardless of whether the patient can pay. So, the hospital passes that charge along to the next guy who can pay.
Also hospitals typically have far more overhead than smaller ambulatory surgery centers and clinics. Simply being larger leads to more bureaucracy and complexity which needs staff. Example of complexity: academic medical center has PET scan, MRI, CT. Small community hospital only has CT. So staff at the academic center need to be either more competent or else have more staff to ensure all the systems are operated correctly.
我认为这主要是因为有能力支付的人在补贴那些无力支付的人。
在美国，医院必须依法治疗急诊室的所有病人，不管他们是否有支付能力。因此，医院将这些成本转嫁给下一个有能力支付的病人身上。
此外，医院通常比小型的门诊手术中心和诊所有更高的运营成本。规模的扩大导致了更多的官僚机构和复杂性，这就需要更多的员工。例如，一个学术医疗中心可能拥有PET扫描、MRI、CT等设备，而小型社区医院可能只有CT。因此，学术中心的工作人员要么需要更有能力，要么需要更多的工作人员来确保所有系统的正确运行。
这主要是因为有能力支付的人在补贴那些无力支付的人。这正是保险的作用，但有了（国家）保险，保费合理，贡献者众多，医院和医生不能随意制定高得离谱的账单。
I believe this is largely driven by using people who can pay to subsidize people who cannot pay.
In the US, hospitals are required to treat all patients in the emergency department regardless of whether the patient can pay. So, the hospital passes that charge along to the next guy who can pay.
Also hospitals typically have far more overhead than smaller ambulatory surgery centers and clinics. Simply being larger leads to more bureaucracy and complexity which needs staff. Example of complexity: academic medical center has PET scan, MRI, CT. Small community hospital only has CT. So staff at the academic center need to be either more competent or else have more staff to ensure all the systems are operated correctly.
我认为这主要是因为有能力支付的人在补贴那些无力支付的人。
在美国，医院必须依法治疗急诊室的所有病人，不管他们是否有支付能力。因此，医院将这些成本转嫁给下一个有能力支付的病人身上。
此外，医院通常比小型的门诊手术中心和诊所有更高的运营成本。规模的扩大导致了更多的官僚机构和复杂性，这就需要更多的员工。例如，一个学术医疗中心可能拥有PET扫描、MRI、CT等设备，而小型社区医院可能只有CT。因此，学术中心的工作人员要么需要更有能力，要么需要更多的工作人员来确保所有系统的正确运行。
这主要是因为有能力支付的人在补贴那些无力支付的人。这正是保险的作用，但有了（国家）保险，保费合理，贡献者众多，医院和医生不能随意制定高得离谱的账单。
In contrast, it sounds like in the UK:
1) there is more rationing which I read to mean more smaller community hospitals vs large academic centers
2) the hospitals aren't worried about patients not being able to pay, so costs are "true" per patient as opposed to including a subsidy for someone else.
相比之下，英国的情况似乎是：
实行了更多的配给制度，我理解为这指的是相比大型学术医疗中心，有更多小型的社区医院。
医院不必担心病人无力支付医疗费用，因此每个病人的成本是“真实”的，并不包括对其他病人的补贴。
1) there is more rationing which I read to mean more smaller community hospitals vs large academic centers
2) the hospitals aren't worried about patients not being able to pay, so costs are "true" per patient as opposed to including a subsidy for someone else.
相比之下，英国的情况似乎是：
实行了更多的配给制度，我理解为这指的是相比大型学术医疗中心，有更多小型的社区医院。
医院不必担心病人无力支付医疗费用，因此每个病人的成本是“真实”的，并不包括对其他病人的补贴。
John Barber
I believe this is largely driven by using people who can pay to subsidize people who cannot pay. Well that’s exactly what insurance is, except with (national) insurance the premiums are reasonable, the pool of contributors is huge and the hospitals and doctors can’t just make up ridiculously high bills on an ad hoc basis.
我认为这种情况主要是由于有能力支付的人群在资助那些无力支付的人。这实际上就是保险的工作原理，但国民保险的特点是保费合理，参与的人数众多，医院和医生不能随意制定过高的医疗费用。
I believe this is largely driven by using people who can pay to subsidize people who cannot pay. Well that’s exactly what insurance is, except with (national) insurance the premiums are reasonable, the pool of contributors is huge and the hospitals and doctors can’t just make up ridiculously high bills on an ad hoc basis.
我认为这种情况主要是由于有能力支付的人群在资助那些无力支付的人。这实际上就是保险的工作原理，但国民保险的特点是保费合理，参与的人数众多，医院和医生不能随意制定过高的医疗费用。
Hari Raghavan
As Glyn Williams indicates, the hospital system also deserves a big chunk of the blame: they are wildly lacking in price transparency (hospitals within a few miles of each other charge 5-10x the price of others), which doesn't introduce anything resembling competition or efficient pricing into the marketplace.
Additionally, I absolutely feel that doctors are underpaid relative to their time, effort and monetary investment; but the magnitude of investment in the first place is due to several runaway costs and poor incentive systems in place (rampant rise in tuition due to high demand for medical professionals, compounded by the number and amount of student loans administered). Someone has to pay for this and it's passed along from the doctors, then to the hospitals, then to the insurance companies and ultimately to the payers (whether consumers or government, and the latter then passes it on to the taxpayers anyway).
格伦·威廉姆斯指出，医院体系本身也应负有重要责任：它们在价格上缺乏透明度（彼此仅几英里的医院对相同服务的收费可能相差5到10倍），这并没有在市场上形成任何竞争或有效定价的机制。
此外，我坚信，相较于医生们的投入——包括时间、努力和经济投资——他们的收入是偏低的。这种高额投资的根源在于一些失控的成本和不良的激励机制，比如由于对医疗专业人员的高需求导致的学费激增，以及学生贷款的数量和金额的增加。这些成本最终需要有人承担，它们从医生传递到医院，再到保险公司，最后落到支付者身上——无论是消费者还是政府，而政府最终会将这些成本转嫁给纳税人。
As Glyn Williams indicates, the hospital system also deserves a big chunk of the blame: they are wildly lacking in price transparency (hospitals within a few miles of each other charge 5-10x the price of others), which doesn't introduce anything resembling competition or efficient pricing into the marketplace.
Additionally, I absolutely feel that doctors are underpaid relative to their time, effort and monetary investment; but the magnitude of investment in the first place is due to several runaway costs and poor incentive systems in place (rampant rise in tuition due to high demand for medical professionals, compounded by the number and amount of student loans administered). Someone has to pay for this and it's passed along from the doctors, then to the hospitals, then to the insurance companies and ultimately to the payers (whether consumers or government, and the latter then passes it on to the taxpayers anyway).
格伦·威廉姆斯指出，医院体系本身也应负有重要责任：它们在价格上缺乏透明度（彼此仅几英里的医院对相同服务的收费可能相差5到10倍），这并没有在市场上形成任何竞争或有效定价的机制。
此外，我坚信，相较于医生们的投入——包括时间、努力和经济投资——他们的收入是偏低的。这种高额投资的根源在于一些失控的成本和不良的激励机制，比如由于对医疗专业人员的高需求导致的学费激增，以及学生贷款的数量和金额的增加。这些成本最终需要有人承担，它们从医生传递到医院，再到保险公司，最后落到支付者身上——无论是消费者还是政府，而政府最终会将这些成本转嫁给纳税人。
Andrew Gage
I would love to see the cost/expense breakdown that justifies a $13 per pill Tylenol bill levied by hospitals. Everything that is given you as treatment in a US hospital is a form of financial rape.
我很想知道，医院如何解释将泰诺林每粒药片的价格定为13美元的成本和费用明细。在美国医院接受的任何治疗都感觉像是在被金融掠夺。
I would love to see the cost/expense breakdown that justifies a $13 per pill Tylenol bill levied by hospitals. Everything that is given you as treatment in a US hospital is a form of financial rape.
我很想知道，医院如何解释将泰诺林每粒药片的价格定为13美元的成本和费用明细。在美国医院接受的任何治疗都感觉像是在被金融掠夺。
Wendy Barnes
Where do you think facilities get the money to pay for the uninsured?
你认为医院从哪里获得资金来支付未参与保险的病人的费用？
Where do you think facilities get the money to pay for the uninsured?
你认为医院从哪里获得资金来支付未参与保险的病人的费用？
Michael Critelli
I would add one more comment to your thoughtful, complete and compelling answer. In many other countries, primary care physicians are more plentiful, they are paid better, and they are the gatekeepers to more expensive specialists. In America, we do a poor job controlling the way Americans access healthcare. Many patients go straight to specialists, who prescribe expensive and intensive treatments. Closely related to this is the fact that we have allowed health records to be kept in separate provider silos, which means that no physician has a complete record of the patient’s care elsewhere. We allow duplicative and dysfunctional care because of a poorly-designed health record system.
我对你的深入、全面且有说服力的回答还有一点补充。在许多其他国家，基层医疗的医生数量更充足，收入也更高，他们充当着通往更昂贵专科服务的守门人角色。然而在美国，我们对民众获取医疗服务的方式控制不严。许多患者直接求助于专科医生，而这些医生往往会推荐费用较高且复杂的治疗方案。与此紧密相关的是，我们允许健康档案分散在不同的医疗服务提供者手中，导致没有一位医生能够全面掌握患者在其他地方接受的治疗情况。由于健康档案系统设计不佳，我们容忍了重复和效果不佳的医疗服务。
I would add one more comment to your thoughtful, complete and compelling answer. In many other countries, primary care physicians are more plentiful, they are paid better, and they are the gatekeepers to more expensive specialists. In America, we do a poor job controlling the way Americans access healthcare. Many patients go straight to specialists, who prescribe expensive and intensive treatments. Closely related to this is the fact that we have allowed health records to be kept in separate provider silos, which means that no physician has a complete record of the patient’s care elsewhere. We allow duplicative and dysfunctional care because of a poorly-designed health record system.
我对你的深入、全面且有说服力的回答还有一点补充。在许多其他国家，基层医疗的医生数量更充足，收入也更高，他们充当着通往更昂贵专科服务的守门人角色。然而在美国，我们对民众获取医疗服务的方式控制不严。许多患者直接求助于专科医生，而这些医生往往会推荐费用较高且复杂的治疗方案。与此紧密相关的是，我们允许健康档案分散在不同的医疗服务提供者手中，导致没有一位医生能够全面掌握患者在其他地方接受的治疗情况。由于健康档案系统设计不佳，我们容忍了重复和效果不佳的医疗服务。
Matthew Milford
My PCP is essentially useless for all but the most basic of problems. One time he prescribed me an ointment, but otherwise, he has always directed me to a specialist. Skin problem? Dermatologist. Low libedo? Endocrinologist. Again and again. I hardly bother him anymore and if I have a problem with [body part] I just make an appointment with a [body part]ologist.
我的家庭医生对于除了最基本问题之外的事情基本上没什么用。有一次他给我开了一种药膏，但除此之外，他总是把我转给专科医生。皮肤问题？看皮肤科医生。性欲低下？看内分泌科医生。一次又一次。我现在很少麻烦他了，如果我身体的某个部位有问题，我就直接预约那个方面的专科医生。
My PCP is essentially useless for all but the most basic of problems. One time he prescribed me an ointment, but otherwise, he has always directed me to a specialist. Skin problem? Dermatologist. Low libedo? Endocrinologist. Again and again. I hardly bother him anymore and if I have a problem with [body part] I just make an appointment with a [body part]ologist.
我的家庭医生对于除了最基本问题之外的事情基本上没什么用。有一次他给我开了一种药膏，但除此之外，他总是把我转给专科医生。皮肤问题？看皮肤科医生。性欲低下？看内分泌科医生。一次又一次。我现在很少麻烦他了，如果我身体的某个部位有问题，我就直接预约那个方面的专科医生。
Alan Higgins
That’s his job, weed out the bumps and bruises and direct to the appropriate specialist. Do you know weather you need and oncologist or a proctologist, no you don’t
他的职责是分辨出轻微的外伤，并将患者指引到合适的专科医生那里。你自己怎么能确定是需要肿瘤科医生还是肛肠科医生呢？你并不清楚。
That’s his job, weed out the bumps and bruises and direct to the appropriate specialist. Do you know weather you need and oncologist or a proctologist, no you don’t
他的职责是分辨出轻微的外伤，并将患者指引到合适的专科医生那里。你自己怎么能确定是需要肿瘤科医生还是肛肠科医生呢？你并不清楚。
Joyce Touche
I was discharged from a VA hospital the end of Feb. after a vicious bout with the flu, and on continuous oxygen. The tech told me to make an appointment with my PCP. I walked to her office and was told the first available appointment was June 21. I called back, and, well, May 15. I called the patient advocate and made it in April 20. I was discharged Feb 27. Had I not been a nurse, I may have ended up dead. They rolled me out to the door, no instructions, no emergency number and a lot of unanswered questions.
二月底，我在一场剧烈的流感后从退伍军人医院出院，需要持续使用氧气治疗。技术人员建议我预约我的家庭医生。我走到她的诊所，却被告知最早的可预约时间是6月21日。我再次打电话，预约时间提前到了5月15日。通过联系患者权益倡导者，我最终在4月20日得到了预约。我是2月27日出院的。如果我不是一名护士，我可能已经不幸去世了。出院时，他们没有给我任何具体指导，没有紧急联系电话，却留下了许多未解答的问题。
I was discharged from a VA hospital the end of Feb. after a vicious bout with the flu, and on continuous oxygen. The tech told me to make an appointment with my PCP. I walked to her office and was told the first available appointment was June 21. I called back, and, well, May 15. I called the patient advocate and made it in April 20. I was discharged Feb 27. Had I not been a nurse, I may have ended up dead. They rolled me out to the door, no instructions, no emergency number and a lot of unanswered questions.
二月底，我在一场剧烈的流感后从退伍军人医院出院，需要持续使用氧气治疗。技术人员建议我预约我的家庭医生。我走到她的诊所，却被告知最早的可预约时间是6月21日。我再次打电话，预约时间提前到了5月15日。通过联系患者权益倡导者，我最终在4月20日得到了预约。我是2月27日出院的。如果我不是一名护士，我可能已经不幸去世了。出院时，他们没有给我任何具体指导，没有紧急联系电话，却留下了许多未解答的问题。
Dani Rhian
I resonate with your comment so much, however, now it’s 2022 and I think this has started to improve right? I’m from Texas, and I’ve been in both corporate and on the end floor while being employed with more than one provider. This was the absolute most frustrating thing to me that EHR (at least) wasn’t accessible across the board using an NPN based system. Why are medical records still such a hassle when we transitioned from paper charting to electronic over a decade ago?
我非常理解你的评论，但现在已经是2022年了，我想这种情况应该有所改善了吧？我住在德克萨斯，曾在不止一家医疗机构工作过，既有在公司层面，也有在临床一线。最让我感到沮丧的是，电子健康记录（EHR）系统本应提高医疗信息的可访问性，但令我极其懊恼的是，这一系统并没有实现全国性提供者编号（NPN）下的普遍接入。既然我们在十多年前就完成了从纸质记录到电子记录的转变，为何如今获取医疗档案依旧如此不便呢？
I resonate with your comment so much, however, now it’s 2022 and I think this has started to improve right? I’m from Texas, and I’ve been in both corporate and on the end floor while being employed with more than one provider. This was the absolute most frustrating thing to me that EHR (at least) wasn’t accessible across the board using an NPN based system. Why are medical records still such a hassle when we transitioned from paper charting to electronic over a decade ago?
我非常理解你的评论，但现在已经是2022年了，我想这种情况应该有所改善了吧？我住在德克萨斯，曾在不止一家医疗机构工作过，既有在公司层面，也有在临床一线。最让我感到沮丧的是，电子健康记录（EHR）系统本应提高医疗信息的可访问性，但令我极其懊恼的是，这一系统并没有实现全国性提供者编号（NPN）下的普遍接入。既然我们在十多年前就完成了从纸质记录到电子记录的转变，为何如今获取医疗档案依旧如此不便呢？
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