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　　中英文本

　　The NHS

　　国民健康保险制度

　　Health reform in a cold climate

　　遇冷的医改

　　The government's reforms to the NHS are viewed asits biggest failure. They are better than that

　　政府医改被指其最大败笔。“盛名”之下其实难副

　　“WITH the Conservatives there will be no more of the tiresome, meddlesome, top-downrestructures that have dominated the last decade of the NHS.” So said David Cameron in 2009,and many were convinced. Voters made Mr Cameron prime minister in2010 inpart because theConservative Party cut into Labour's lead on health care, which it had enjoyed almost since itfounded the NHS in 1948. The Tories quickly squandered their advantage. But their legacy willbe better than they seem to believe.

　　“有了保守党，NHS(National Health Service 英国国民健康保险制度)近十年主要的恼人、好事、专制的医疗结构会一扫而光”，这是英国首相卡梅伦在2009年说过的话，且广受信服。2010年，选民把戴维·卡梅伦选为首相，有部分原因是因为保守党插手了工党主导的医疗保健项目，这个项目几乎自从1948年设立了NHS就赞誉颇多。然而保守党很快就把优势糟蹋一空。但“遗产”比他们大部分人认为的要丰厚。

　　In spite of his promise, Mr Cameron's Conservative-Liberal Democrat coalition governmentembarked on reforms that would reshape the NHS from the top down. The immense Healthand Social Care Act of 2012 increased competition, gave the service greater autonomy andput more decisions about the purchase of care in the hands of local doctors, known inBritainasgeneral practitioners, or GPs. The changes were so big that they could be seen from space,quipped Sir David Nicholson, the departing head of the NHS.

　　即便是承诺在前，卡梅伦领导的保守党和自由民主党联合政府着意的改革仍将自上而下的改造NHS。2012年，声势浩大的医疗社会保障法案使竞争更加激烈，给医疗服务业更大的自主权，以及把决定医疗开销的权利交由本地医生掌握，这类医生在英国被称为全科医生，简称全医。NHS前主管戴维·尼克尔森爵士曾调侃，这么大的变革，在太空都能看到。

　　The government soon came to wish they would disappear. The reforms were never popularwith a bemused public. Doctors' groups argued they would lead to a more fragmented andprivatised system. Others worried that GPs would be incapable of commissioning care. EdMiliband, Labour's leader, dubbed the reforms Mr Cameron's “poll tax”, a reference to thepolicy that helped fell Margaret Thatcher. In this case it was Andrew Lansley, the healthsecretary, who fell. Less than six months after his reforms were passed, Mr Lansley wasreplaced by Jeremy Hunt, who talks about them as little as possible.

　　很快，政府就希望这些变革能尽快消失。迷惑的民众并不欢迎这些改革。医生群体称，这个权利会让他们最终导致一个更加零碎化、私有化的医疗系统。还有人担心，全科医生并没有能力被委任护理。工党领袖埃德·米利班德把这些改革戏称为卡梅伦的“人头税”，一个曾经让撒切尔夫人下台的参考政策。而现在，下台的是卫生部长安德鲁·兰斯。兰斯的改革通过不到六个月内，他就被杰里米·亨特代替了，而后者几乎对改革只字不谈。

　　The health reforms were supposed to make the NHS more independent. Yet Mr Hunt nowstyles himself a patients' champion—he is known to ring hospitals to ask about waiting times.This is a concession to reality: politicians will always be held accountable for the performanceof the NHS. Still, the frantic smothering of the reforms conceals something useful. A policy thathas caused the government so much embarrassment is quietly bearing fruit.

　　医疗改革旨在让NHS更加独立。然而杰里米·亨特现在自比为病人的胜利，因为大家都知道他常常打电话给医院询问等待时间。这是承认现实：政客永远要为NHS的表现负责。但是，改革密不透风的大动干戈掩盖了一些有用的东西。一个让政府非常窘迫的政策正静悄悄地开花结果。

　　Let 211 flowers bloom

　　让211之花盛开

　　The biggest change was the creation of 211 Clinical Commissioning Groups (CCGs), whichplaced about 60% of the NHS budget in the hands of local doctors and health workers. Theybecame responsible for procuring hospital care, mental-health services and the like. Navigatinga muddled system, the cannier ones have figured out ways to realign the incentives ofhospitals, which are often paid per procedure, with those of GPs, who aim to keep peoplehealthy and at home.

　　最大的改变是211临床调试组(CCGs)这一创举，收纳了本地医生和医务人员手中60%的NHS预算。调试组负责采购医院护理、心理健康护理之类的物品。游走在混乱的医疗系统中，头脑灵活的人已经想出办法调整对医院的刺激，这些在每次采购中都会被全科医生偿付，他们旨在使病人保持健康，觉得自在。