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China's punctured health care system
讓人泄氣的中國醫療保健體系
原文地址：http://news.bbc.co.uk/1/hi/programmes/from_our_own_correspondent/7477184.stm
原創翻譯
After years of free market reform, the old communist- provision of cradle-to-grave welfare in China is a distant memory for anyone under 30. For millions of the country's less wealthy, this means that basic healthcare is simply unaffordable, the BBC's Jill McGivering reports from Beijing.
經過這些年的自由市場改革后，在中國以前那種具有共產主義供給特色涵蓋生老病死的社會保障制度，對如今30歲以下的人來說那是一種遙遠的記憶。對於該國數百萬不富裕的人來說，這意味著基本的醫療保健都難以負擔得起。BBC記者Jill McGivering發自北京的報道。
The hospital corridor was dingy and smelt of urine. The peeling paint and cracked floor tiles exuded shabbiness and it was made narrower by the trolleys parked down the sides. On one trolley lay an old man, hollow-cheeked, and vomiting into a bag. His middle-aged son hovered by him, looking embarrassed and hopeless.
這家醫院的走廊骯髒昏暗散發著一股尿臊味。剝脫的油漆和裂開的地面磚讓這裡看上去破爛不堪，而堆放在一旁的手推車讓走廊更加狹窄。在一輛手推車上躺著一位面色萎黃的老人，他正往一個袋子里嘔吐。他的中年兒子在他身邊走來走去，看上去很窘迫和無助。
On another, I found a young man, lying on his back, attached to a drip. His face was young and serene, his eyes closed. He was unconscious. His wife, a pretty young woman in her 20s, bent over him, touching his face. She seemed bewildered. In all the chaos, no-one was paying her much attention. Her husband had been knocked off his bicycle by a car, she told me as she stared up blankly at the clock - less than three hours ago. He had not regained consciousness.
在另一邊，我看到一名年輕人仰面躺著掛著點滴。他的面看上去年輕而安詳，兩眼閉著。他沒有知覺。他妻子，一位20多歲相當漂亮的年輕婦女，伏在他身上，撫摸著他的臉。她似乎一片茫然。在一片忙亂中，沒人給她投來更多的關注。她面無表情地盯著鍾告訴我，她丈夫在不到三小時前騎自行車時被汽車撞了。到目前為止他還沒有恢復意識。
They were both from the countryside, she said, and were here in Beijing to work. But whatever insurance they had was not valid in the city. I asked what his injuries were, what treatment he needed. She shrugged. "It must be serious," she said, gazing down again at her young husband's still face. Maybe the man who knocked him down would pay the bills?
她說他們都是從農村來到北京打工的。但是不管他們以前有什麼樣的保險在城市裡都無效。我問他傷在哪裡，需要進行什麼樣的治療。她再次凝視著她年輕的丈夫那張安寧的臉聳聳肩說，「傷一定很嚴重」。可能那個撞倒他的人會付錢吧。
'Barefoot doctors'
「赤腳醫生」
These snapshots of poverty and hopelessness seem out of place in modern China, with the new Beijing airport and its visionary roof which soars and ripples like a cresting wave. The streets of China's cities ooze wealth. Roads are jammed with new cars, gleaming skyscrapers, designer clothes... all against the endless soundtrack of construction drills. But amid this dynamism and growth, China is having a health care crisis.
這些貧窮和無助的景象似乎與現代化的中國不相稱，看看新的北京機場，它夢幻般的頂篷捲起如波峰的陣陣漣漪。中國城市的街道處處流露出富裕。在一刻不停的建築打樁聲襯托下，馬路上擠滿了新車，光閃閃的摩天大樓，名牌時裝……不過在這種活力和增長中，中國面臨著一場醫療保健危機。
Not many here miss Mao. By comparison with those dark days, there is more freedom today, more opportunity and much more money. But in the old days, healthcare was free or almost free through work units and state enterprises.
現在沒有很多人還懷念毛澤東（的時代）。對照以前那些黑暗的日子，如今有更多的自由，更多的機會和更多的錢。但是在以前憑工作的單位和國營企業，醫療保健是免費的或基本免費的。
China had its famous barefoot doctors - an impressive network of rural health workers - farmers with a rudimentary training. Anything complicated they had to refer to proper doctors in hospitals, but they held the health frontline. When the wind of economic reform began to blow in the 1980s they were swept away. Many small clinics went too. Health became, like so much else, subject to market forces. Those with money could buy a higher standard of care. Those without were the people I was meeting in Beijing's cheaper public hospitals.
中國曾經有著名的赤腳醫生——這個讓人印象深刻的農村衛生工作者體系——就是給農民進行基本的（醫療）訓練。碰到任何複雜一些的情況他們必須得（將病人）轉到相關的醫院和醫生那裡，不過他們堅守在醫療保健的前線。當八十年代經濟改革之風開始席捲的時候，他們也被清除掉了。許多小診所也隨之而去。像其他許多事情一樣，醫療保健也受到了市場的衝擊。有錢人可以買到更高標準的照顧。那些沒錢的就是那些我在北京便宜的公立醫院裡遇到的人們。
'Westernised deaths'
「西化之死」
The collapse of services for the poor has been complicated by the way China's need for healthcare is changing as rapidly as its skylines. Before, people died from things like pneumonia and tuberculosis. Now, they sit in cars instead of walking or cycling, eat fattier diets with more meat... and they smoke. Their lives are more Westernised. So too are their deaths.
對窮人（醫療）服務的崩潰原因複雜，同時中國對醫療保健的需求就像它的天際線變化的那樣快。以前，人們死於肺炎和肺結核。現在他們坐車取代了步行和騎自行車，吃得更富含脂肪的飲食，更多的肉食……還有他們吸煙。他們的生活越來越西化，所以死亡譜也與西方接近。
Four out of five people in China now die from non-communicable diseases: cancer, heart disease and strokes. Treatment for these is complicated, expensive and likely to last for years. This is quite a challenge for 1.3 billion people, many millions of them still poor. The government is struggling to change course. It has woken up to the fact that health is not just about welfare but political too.
在中國現在五分之四還要多的人死於非傳染性疾病：癌症、心臟病和中風。對這些病的治療複雜、昂貴並得持續數年。這對13億人口來說是一個相當大的挑戰，其中數百萬人還很貧窮。政府正在費力地改變（改革）方向。中國已經在這樣的現實面前醒悟過來，醫療保健不僅僅關於福利制度的問題同時也是政治問題。
The burden of health fees has sparked rage in the countryside. Those who feel excluded from the boom realise their meagre savings are under constant threat. If they become chronically ill, they could become bankrupt too. So the government is suddenly pumping billions into new social insurance schemes. Seven hundred million people across China's vast countryside have now signed up for a new rural health scheme whereby a small annual fee from each person is matched by a payment from the state.
醫療費用負擔在農村已經引發了憤怒。那些感到被排斥在經濟繁榮之外的人們意識到他們微薄的積蓄不斷受到威脅。如果他們患上慢性病，他們可能也要面臨破產。因此政府向新的社會保險方案迅速注入數十億元。在中國廣大農村7億人現已納入了一個新的農村醫療保健體系，根據那個方案每個人每年付一小筆費用，國家將出另一筆錢與之匹配。
It gives some cover, but not enough. Only a percentage of medical bills is covered and in some cases, a very small percentage. Chronic illness can still bankrupt an entire family. So it is a safety net, but one that is full of holes.
這能提供一些保障，但還是不夠。僅僅一部分醫療賬單被包括在內，有時候是占非常小的比例的。慢性病依然能拖垮一個完整的家庭。儘管這是一個安全保障網路，但是是一個滿是孔的網。
Tired resignation
疲憊的聽天由命
In another hospital, I found a gaggle of rural patients crouching on the forecourt. They were out-patients, waiting for appointments or test results. I met a white-haired old lady, sitting in the shade on a bare concrete slab. Her clothes were shabby and old-fashioned, her shoes worn and her face lined from the sun. I could tell at a glance she came from the countryside. When I spoke to her, her tone was weary.
在另一家醫院，我一群吵鬧的農村病人蹲在醫院的大廳。他們是門診病人正在等待看病預約或是檢查結果。我碰到一個滿頭白髮的老年婦女坐在一個蔭涼處裸露的水泥板上。她穿著過時衣衫破舊，鞋子也磨破了，日晒讓她的臉布滿皺紋。我一眼就可以辨認出她來自農村。當我和她交談時，她的聲音疲憊。
She had made a long trip by bus to come to Beijing, she said. She struggled to describe what was wrong with her but it sounded like a bowel tumour. Could she afford the tests and possible treatment, I asked? She shrugged and grimaced. She seemed utterly exhausted. "We're just farmers," she said. "We don't have any money. What can we do?"
她說她乘長途汽車來到北京。她費力地描述她的癥狀，不過聽起來像是大腸腫瘤。我問她能不能付得起檢查和可能採取的治療費用。她聳聳肩一臉愁容。她似乎完全精疲力竭了。「我們是一些農民」，她說。「我們沒有錢，我們還能怎麼辦呢？」 | 
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