A wave of covid-19 reveals flaws in China’s health system
It is better than it used to be, but still needs reform
China has made great efforts to build an affordable health system.
Covid-19 is revealing how much remains to be fixed
一波新冠肺炎疫情暴露了中国卫生体系的缺陷
它比以前好多了，但仍需要改革
中国在建设平价医疗体系方面做出了巨大努力。
Covid -19揭示了还有多少问题需要解决
Dec 19th 2022
WITHIN THE next month, China’s medical institutions will face their “darkest hour”. This warning by Zhang Wenhong, a prominent infectious-disease expert, has been circulated by state media. It reflects a view that not long ago would have been treated as heresy in “zero-covid” China. But with the virus now sweeping the country, including its hospitals, talk of crushing it has ceased. People are queuing for hours at fever clinics. Medical staff are falling sick in droves. In the coming weeks deaths will rise rapidly as the disease takes its toll on an undervaccinated population.
prominent
adj. 杰出的；显著的，突出的
circulate
v. 流通, 循环; 传播, 流传, 散布; 传递, 传阅
heresy
n. 宗教异端, 信奉邪说, 离经叛道的信念（或观点）
fever
n. 发热, 发烧, 狂热, 热（病）
v. 使发烧, 使患热病, 使兴奋[发狂]
clinic
n. 诊所，门诊部，科室
drove
n. 畜群
v. 赶(牲畜), (牲畜贩子)买卖(牲畜)
v. “drive”的过去式
in droves
网络 成群结队地; 成群结队; 陆陆续续;
下个月，中国的医疗机构将面临“最黑暗的时刻”。著名传染病专家张文宏的这一警告被官方媒体广为传播。它反映了一种不久前在“零疫情”中国还会被视为异端的观点。但随着病毒现在席卷全国，包括医院，摧毁它的说法已经停止了。人们在发烧诊所排几个小时的队。医务人员成群结队地生病。在未来几周内，死亡人数将迅速上升，因为该疾病对接种疫苗不足的人群造成了损失。
For much of the past three years, since cases of covid-19 were first detected in the central city of Wuhan, the government has viewed its handling of the pandemic with pride. It had succeeded in keeping covid at bay and deaths to an astonishingly small number compared with many other countries. It had also managed to turn this to great propaganda advantage. At least until late this year, when the virus began to run loose and protests erupted over often-brutally enforced lockdowns, many people appeared to buy the official line that China’s accomplishments were the product of a superior political system, one said to be uniquely capable of mobilising people and resources on a scale needed to prevent the virus from spreading.
handling
n. 处理；应付
bay
n. （海或湖的）湾
v. （尤指捕猎时）发出长嗥, 厉声强要
adj. 深棕色的, 栗色的
astonishingly
adv. 令人惊讶地
propaganda
n. （政治）宣传；鼓吹
accomplishment
n. 成就, 完成, 成绩, 技艺
superior
adj. (质量等方面)比…好的, 比…强的; (职位、地位、等级等)更高的; 上级的; 有优越感的; 高傲的
n. 上级, 长官, 级别更高的人; 占优势者; 优质物品
自中部城市武汉首次发现covid-19病例以来，在过去三年的大部分时间里，政府一直以其对大流行的处理为荣。与许多其他国家相比，它成功地遏制了covid，死亡人数少得惊人。它还成功地将这一点转化为巨大的宣传优势。至少在今年晚些时候，当病毒开始蔓延，抗议活动爆发时，许多人似乎都相信官方的说法，即中国的成就是优越的政治制度的产物，据说中国有独特的能力动员大规模的人员和资源，以防止病毒传播。
With zero-covid now all but abandoned and streets near-emptied not by lockdowns but by fear, the public’s attention is turning to the health-care apparatus. In recent days calls in Beijing to 120, the number for medical emergencies, have risen to five or six times the normal level. “Covid chaos”, as a newspaper in Beijing called it, has broken out in hospitals. People in many cities have been flocking to them, terrified even by mild infection with the virus. They were once told that it posed a grave threat to their lives. Now, dismissively, officials are calling the current Omicron variant flu-like. But immunity to covid is low in China, so the ballooning number of cases will result in many deaths: about 1.5m in the next few months, by The Economist’s worst-case estimate.
apparatus
n. 装置，器具，机构，组织
terrified
adj. 恐惧, 很害怕
v. “terrify”的过去式和过去分词，使恐惧，使十分害怕
mild
adj. 温和的；和善的；不严厉的；和煦的
dismissive
adj. 轻蔑的, 鄙视的
immunity
n. 免疫力, 豁免, 受保护, 免除
ballooning
n. 热气球运动
随着零冠病毒现在几乎被废弃，街道几乎因封锁而空无一人，而是因为恐惧，公众的注意力转向了医疗机构。最近几天，北京紧急医疗呼叫电话达到120，是正常水平的五到六倍。北京一家报纸所称的“新冠乱象”在医院爆发。许多城市的人们都涌向他们，即使是轻微的病毒感染也会让他们害怕。他们曾被告知，这对他们的生命构成了严重威胁。现在，官员们轻蔑地称目前的欧米克隆变种类似流感。但中国对新冠病毒的免疫力很低，因此不断膨胀的病例数量将导致许多人死亡:根据《经济学人》最坏的估计，在未来几个月里，大约有150万人死亡。
Fatalities on such a scale would still be lower, as a share of the population, than seen in many other countries as a result of covid. But they will raise questions in China about weaknesses in the country’s health-care system and whether they may have contributed to people’s suffering and the ordeal of medical staff.
Fatality
n. 宿命, （事故、战争、疾病等中的）死亡, （疾病的）致命性, 听天由命
ordeal
n. 折磨, 磨难, 煎熬, 严酷的考验
与许多其他国家相比，这种规模的死亡人数占人口的比例仍将较低。但它们将在中国引发人们对中国医疗体系缺陷的质疑，以及它们是否可能加剧了人们的痛苦和医务人员的折磨。
It would not be the first time for such soul-searching. An outbreak of SARS, which was first detected in China in 2002 and killed hundreds, mostly within China, prompted much debate about the system’s failings. Having initially covered up the emergence of SARS, officials became more open. Henk Bekedam, then the World Health Organisation’s chief representative in Beijing, recalls a study by Chinese government researchers, funded by the WHO, that was completed in 2005. China Youth Daily, a state-controlled newspaper, revealed details of it with an eye-catching headline: “China’s health reforms have not succeeded”. It was “quite something” to see those words, says Mr Bekedam.
prompt
adj. 迅速的，立刻的；敏捷的
v. 激起，促进，推动；提示
n. 〔计算机屏幕上的〕提示符；〔给演员的〕提词，提白
initially
adv. 最初, 开始, 起初
这种自我反省已经不是第一次了。2002年，SARS首次在中国被发现，导致数百人死亡，其中大部分是在中国境内。SARS的爆发引发了人们对医疗体系缺陷的激烈讨论。在最初掩盖了SARS的出现之后，官员们变得更加公开。时任世界卫生组织(WHO)驻北京首席代表贝克达姆(Henk Bekedam)回忆起了一项由中国政府研究人员在世卫组织资助下于2005年完成的研究。国有报纸《中国青年报》以醒目的标题披露了该计划的细节:“中国的医疗改革没有成功”。Bekedam先生说，看到这些话“很了不起”。
Under Xi Jinping, who became China’s leader a decade ago, public acknowledgment of policy error would be harder to imagine. Perhaps, he may feel, there is less need of one. Much has been done to remedy the problems that SARS highlighted.
acknowledgment
n. 承认；承认书 (“acknowledgement”的变体)；感谢，致谢
remedy
n. 解决方法，解决良方；药品，治疗方法
v. 改正；纠正；改善
在十年前成为中国领导人的习近平的领导下，公开承认政策错误将更加难以想象。 也许，他可能觉得，不需要那么多了。 为了解决 SARS 突出的问题，已经做了很多工作。
A big one was the public’s fear of any contact with the health system because of the high cost of getting treated. Before SARS, community-level care had crumbled. Many state-owned enterprises and the “people’s communes” that had once provided health services had been dismantled. Hospitals remained under state control but had become market-driven. To pad their budgets and the wallets of their staff they could set their own prices for drugs and treatments. In cities, only people with formal job contracts had access to insurance. Most of China’s 900m rural dwellers had to pay for their own medical expenses.
crumble
v. 崩溃, 崩裂, 瓦解, 成碎屑
n. 酥皮水果甜点
dismantle
v. 拆开, 取消
formal
adj. 适合正式场合的，庄重的；正式的；合乎规矩的
n. （正式的）舞会；（女子的）正式礼服
rural
adj. 乡下的；乡村的；农村的；有乡村特色的；田园的；有乡土气息的
dweller
n. 居民, 居住者, 栖身者
一个很大的原因是公众害怕与医疗系统有任何接触，因为接受治疗的费用很高。在非典之前，社区一级的医疗服务已经崩溃。许多曾经提供保健服务的国有企业和”人民公社”已被拆除。医院仍由国家控制，但已成为市场驱动。为了充实预算和员工的钱包，他们可以自行制定药品和治疗的价格。在城市里，只有有正式工作合同的人才能买到保险。在中国9亿农村居民中，大多数人不得不自己支付医疗费用。
After SARS, officials ramped up efforts to enroll rural residents in a government-funded health-insurance scheme. In 2007 they did the same in cities among those without formal jobs. Two years later the government unveiled a plan for health reform that aimed to provide affordable, basic care for everyone (“universal health coverage”, as the WHO calls it) by 2020. It involved a big increase in government spending. The government’s annual outlay on health as a share of GDP tripled to about 3% compared with the amount being spent at the time of SARS, the WHO reckons (see chart 1). By 2011 more than 95% of China’s population had some form of government-financed health insurance. By 2017 the number of health workers per person had increased by more than 85% and the number of hospital beds by nearly 145%.
ramp
n. 匝道, 斜坡, 坡道, （装车或上下飞机的）活动梯
v. 诈骗, 【纹章】(狮子等)用后脚直立, 作恫吓姿势, 猛扑
enroll
v. （使）加入；注册；登记
scheme
n. 计划，方案；体系；体制；阴谋
v. 密谋，图谋
unveil
v. 公布, 推出; 为…揭幕, 揭开…上的覆盖物
outlay
n. （启动新项目的）开支
非典之后，官员们加大力度让农村居民参加政府资助的医疗保险计划。2007年，在城市中没有正式工作的人也采取了同样的措施。两年后，政府公布了一项医疗改革计划，旨在到2020年为每个人提供负担得起的基本医疗服务(世界卫生组织称之为“全民医保”)。这涉及到政府开支的大幅增加。世界卫生组织估计，与SARS时期相比，政府的年度医疗支出占GDP的比重增加了两倍，达到3%左右。到2011年，超过95%的中国人口拥有某种形式的政府资助的医疗保险。到2017年，人均卫生工作者人数增加了85%以上，医院床位数量增加了近145%。
Lessons from Wuhan
Much, then, to crow about. But the eruption of covid in 2019 showed that a lot remained to be done. The SARS outbreak, tiny by comparison, had revealed woeful inadequacy in China’s disease-surveillance apparatus. With American help, China tried to remedy this by training hundreds of people in how to respond to such events. But covid was rampant in Wuhan by the time the chief of the Chinese Centre for Disease Control and Prevention, George Gao, learned about it, according to reports.
crow
n. 乌鸦, 喔喔叫声
v. （尤指在清晨）啼叫, 自鸣得意, 欢叫
eruption
n. 【地】喷发, 迸发, 【医】疹, (牙齿)冒出
comparison
n. 比较，对照
woeful
adj. 糟糕的, 严重的, 不合意的, 悲惨的
apparatus
n. 装置，器具，机构，组织
remedy
n. 解决方法，解决良方；药品，治疗方法
v. 改正；纠正；改善
rampant
adj. 泛滥的, 猖獗的, 疯长的
那么，有很多值得夸耀的东西了。但2019年新冠肺炎疫情的爆发表明，还有很多工作要做。相比之下，SARS的爆发微不足道，却暴露了中国疾病监测设备的严重不足。在美国的帮助下，中国试图通过培训数百人如何应对此类事件来解决这一问题。但据报道，当中国疾病预防控制中心主任乔治·高了解到这一情况时，covid已经在武汉猖獗。
What unfolded in Wuhan in 2020 exposed wider problems in the health-care system. The government’s efforts to rebuild community-level care, and make it act as a gateway to hospitals like Britain’s general-practitioner (GP) clinics, had clearly made little progress. Terrified residents of Wuhan, often with only mild symptoms of covid, rushed straight to hospitals—disdainful (as many Chinese are) of neighbourhood health centres where doctors tend to be less well-trained and equipment inferior. Writing in the Chinese Journal of Health Policy, four academics in Wuhan described the scene as “chaotic”, like a bank run. Community health centres proved of little use. Their doctors were summoned to help out in hospitals. A national plan for health-care development had called for community clinics to have 3.5 health workers per 1,000 residents served by 2020. At the start of the pandemic, Wuhan’s had only 2.7, the scholars noted. Stripped of their bare-bones staff, some clinics had to close as the virus swept the city.
unfold
v. （使）展开，打开；（使）逐渐展现，展示；透露
gateway
n. 网关, 途径, 门道, 手段
Terrified
adj. 恐惧, 很害怕
v. “terrify”的过去式和过去分词，使恐惧，使十分害怕
disdainful
adj. 轻视的, 鄙视的, 倨傲的
inferior
adj. 次等的，较差的；（级别）较低的
n. （级别）较低的人；不如他人的人
chaotic
adj. 混乱的, 杂乱的, 紊乱的
summon
v. 传唤；召集，召开；吁求，请求；鼓起，振作
Strip
n. 条，带；狭长地带，带状水域；队服；连环漫画
v. 剥夺；扒光…的衣服；进行脱衣表演
2020年在武汉发生的事情暴露了医疗体系中更广泛的问题。政府努力重建社区护理，并使其成为像英国全科医生诊所那样的医院的门户，但显然进展甚微。吓坏了的武汉居民，通常只有轻微的covid症状，直接冲进了医院——他们(和许多中国人一样)不屑于社区医疗中心，那里的医生往往没有受过良好的训练，设备也较差。武汉的四位学者在《中国卫生政策杂志》上撰文称，当时的情景“混乱”，就像银行挤兑一样。事实证明，社区保健中心用处不大。他们的医生被召集到医院帮忙。一项国家卫生保健发展计划要求到2020年，社区诊所每1,000名居民拥有3.5名卫生工作者。学者们指出，在大流行开始时，武汉只有2.7个。随着病毒席卷这座城市，一些诊所失去了最基本的员工，不得不关闭。
Days after the first covid-related death was announced, the tide began to turn. A citywide lockdown was imposed. The city’s government began demanding that citizens with symptoms be escorted to community health centres for checks. This helped to ease some of the pressure on hospitals. But the clinics struggled to cope. Many people with chronic conditions such as high blood pressure or diabetes had been getting their medicine and check-ups at hospitals. When hospitals stopped providing such services to limit the flow of people, community facilities were supposed to take up the reins. They were unprepared. “Throughout the city, it became difficult for outpatients with chronic diseases to see a doctor or get their medicine,” the academics said.
escort
v. 护卫，护送
n. 陪侍者；护卫者
facility
n. 设备，设施； 附加服务，附加功能；天赋；娴熟，灵巧
reins
n. 激情, 肾脏, 腰部, 缰绳, 控制, 主宰, 掌管
v. “rein”的第三人称单数
rein
n. 控制, 缰绳, （幼儿佩带以防走失的）保护带, 主宰
v. 控制, 箝制, 抑制(情欲等), 给(马)套上缰绳
outpatient
n. 门诊病人
在宣布首例与covid相关的死亡病例数天后，形势开始逆转。全城都被封锁了。该市政府开始要求有症状的公民被护送到社区卫生中心进行检查。这有助于减轻医院的一些压力。但诊所却难以应付。许多患有高血压或糖尿病等慢性病的人一直在医院接受药物治疗和检查。当医院停止提供此类服务以限制人员流动时，社区设施应该接管这一工作。他们毫无准备。学者们说:“在整个城市，慢性病门诊患者看病或取药变得困难。”
As the virus runs rampant again, officials are trying to show they are better prepared. The city government in Beijing says that by the end of November—a week before the main mechanisms of zero-covid were dismantled—240 of the capital’s community health centres had set up fever clinics. Within another few days the remaining 110 or so had opened them, too.
rampant
adj. 泛滥的, 猖獗的, 疯长的
随着病毒再次猖獗，官员们正试图表明他们已经做好了更好的准备。北京市政府表示，截至11月底——在零冠主要机制被拆除的一周之前——首都240家社区卫生中心已经设立了发烧诊所。又过了几天，剩下的110个左右也打开了。
But until recently they had not been busy vaccinating people. Amy, a vlogger in the city of Kunming, says she was fully vaccinated at her local clinic six months ago, but has heard nothing from them since about a booster. (Chinese-made vaccines, the only type permitted in China, are less effective than the ones commonly used in rich countries.) She has just tested positive, with mild symptoms. Were it to get more serious, official advice is that she go first to her community clinic. But Amy insists she would go to hospital, despite the queues and brevity of consultations. The quality of care is better there, she says.
vlogger
n. 视频博主
booster
n. (火箭) 助推器; (电器) 增压器; (药物) 加强剂; 起推动作用的事物; 支持者, 拥护者
brevity
n. 简洁, 简练, 短暂
consultation
n. 咨询, 磋商, 查阅, 商讨
但直到最近，他们还没有忙着给人们接种疫苗。艾米是昆明市的一名视频博主，她说六个月前她在当地的诊所接种了全面疫苗，但从那以后就没有听到任何关于加强疫苗的消息。(中国生产的疫苗是中国唯一允许生产的疫苗，但效果不如发达国家常用的疫苗。)她刚刚检测呈阳性，症状轻微。如果病情加重，官方建议她先去社区诊所。但艾米坚持要去医院，尽管要排长队，而且问诊时间很短。她说，那里的医疗质量更好。
Trick or treatment?
Amy’s view is not surprising. China’s health-care system, and the ability of its health-care institutions to respond to emergencies such as covid, are still saddled with many of the same problems that were evident during SARS. In 2017 the government stopped allowing hospitals to sell essential drugs at a mark-up as a way of generating revenue—a practice that had been causing huge public resentment. But hospitals still find other ways to make money, such as by prescribing unnecessary treatments, including expensive inpatient care. To attract customers they buy shiny, imported MRI scanners and other diagnostic tools, and charge patients steep prices for tests, as less glamorous but important areas of care are neglected.
Trick
n. 技巧, 诡计, 诀窍, 把戏
v. 欺骗, 欺诈
adj. 意在欺骗的, 容易使人上当的, 虚弱有毛病的
saddle
n. 马鞍, （自行车或摩托车的）车座, （动物的）脊肉
v. 给（马）备鞍；使负担，使承受
resentment
n. 怨恨, 愤恨
attract
v. 吸引, 招引, 使喜爱, 引起…的好感（或爱慕）
shiny
adj. 光亮的, 锃亮的, 反光的, 有光泽的
scanner
n. 扫描仪, 扫描器, 扫描设备, （医用）扫描器
diagnostic
adj. 诊断的, 判断的
n. 诊断, 诊断程序（诊断计算机的错误）
glamorous
adj. 特别富有魅力的, 富于刺激的, 独特的
艾米的观点并不奇怪。中国的医疗保健系统及其医疗机构应对covid等紧急情况的能力仍然面临着许多与SARS期间明显相同的问题。2017年，政府停止允许医院以加价销售基本药物作为创收的一种方式，这种做法引起了公众的极大不满。但医院仍在寻找其他赚钱的方法，比如开不必要的治疗处方，包括昂贵的住院护理。为了吸引客户，他们购买闪亮的进口核磁共振扫描仪和其他诊断工具，并向患者收取高昂的检查费用，因为不那么光鲜但重要的护理领域被忽视了。
Since 2001, thanks to the government’s insurance schemes, out-of-pocket payments for health care have dropped from about 60% of households’ health spending to 30%, according to “Healthy China”, a report in 2019 by the WHO, the World Bank and the Chinese government. But this was still higher than the average of about 20% in the OECD, a club of rich countries.
根据世界卫生组织、世界银行和中国政府在2019年发布的《健康中国》报告，自2001年以来，由于政府的保险计划，自付医疗费用占家庭医疗支出的比例已从约60%下降到30%。但这仍高于富裕国家俱乐部——经合组织(OECD) 20%的平均水平。
The profit motive in hospitals has created a blizzard of distortions. One is evident in the country’s shortage of intensive-care beds, a problem that will worsen as serious cases of covid rise. Before the pandemic, hospitals had pondered their worth. Why spend money on installing them and training specialist staff when a far steadier stream of revenue could be created by focusing on the predictable needs of patients with non-communicable diseases, such as cancer and heart ailments? These are fast-growing as the population ages, lifestyles change and pollution undermines health.
blizzard
n. 【气】暴风雪, 〈非正式〉暴风雪般的一阵, 大量
distortion
n. 扭曲；变形；曲解；失真
ponder
v. 沉思，琢磨，考虑
specialist
n. 专家；专科医生
predictable
adj. 可预见的, 可预料的, 意料之中的, 老套乏味的
ailment
n. 轻病, 小恙
undermine
v. 逐渐削弱（信心、权威等）, 使逐步减少效力, 从根基处破坏, 挖…的墙脚
医院的利润动机造成了一场扭曲的暴风雪。其中之一是该国重症监护床位的短缺，随着covid严重病例的增加，这一问题将进一步恶化。在大流行之前，医院一直在考虑自己的价值。如果专注于非传染性疾病患者(如癌症和心脏病患者)可预见的需求，可以创造更稳定的收入来源，为什么还要花钱安装这些设备和培训专业人员呢?随着人口老龄化、生活方式改变和污染损害健康，这些问题迅速增长。
In early December the government ordered hospitals to ensure their critical-care beds were ready for use by covid patients, including beds earmarked for other kinds of illnesses. This month the government said there were now about ten per 100,000 people—a big increase from recent official figures of about four.
12月初，政府命令医院确保重症监护床位为covid患者准备好，包括指定用于其他疾病的床位。本月政府表示，每10万人中就有10人患有糖尿病，比最近官方数据的4人有了很大的增长。
But The Economist’s modelling suggests that is still only about one-third of the number that may be needed to cope with the covid wave (see chart 2). A paucity of intensive-care capacity had been one of the main reasons for maintaining a zero-covid policy. Ramping it up now will not be helped by a chronic shortage of nurses with the necessary skills. Those who suffer most from the critical-care deficit will be people living in places other than the biggest cities, where the fanciest hospitals are concentrated. In the countryside many village “doctors” do not even have a university degree.
model
n. 型, 模范, 典型, 模特儿
adj. 模范的
v. 做模特儿, （向顾客）穿戴展示, 将…做成模型, 复制
paucity
n. 少量, 少许, 贫乏
Ramp
n. 匝道, 斜坡, 坡道, （装车或上下飞机的）活动梯
v. 诈骗, 【纹章】(狮子等)用后脚直立, 作恫吓姿势, 猛扑
chronic
adj. 长期的, 慢性的, 难以治愈（或根除）的, 长期患病的
n. 慢性病人
fancy
v. 想象; 认为; 想要; 迷恋
n. 爱好; 想象的事物; 想象(力)；幻想
adj. 异常复杂的; 太花哨的; 精致的, 有精美装饰的; 异想天开的; 特级的, 优质的
concentrated
adj. 决心要做的, 全力以赴的, 浓缩的, 密集的
v. 集中（concentrate的过去式和过去分词）
但《经济学人》的模型表明，这仍然只是应对新冠疫情所需人数的三分之一左右(见图2)。重症监护能力不足一直是维持零新冠政策的主要原因之一。长期缺乏具备必要技能的护士，现在加大护理力度也于事无补。重症监护赤字的最大受害者将是那些居住在大城市以外地区的人，而大城市是最好的医院集中的地方。在农村，许多乡村“医生”甚至没有大学学位。
The government is clearly aware of the problem. Its latest health-reform plan, published in 2016, stresses the need for an effective primary-care system. It has spent billions of dollars on beefing up community-level facilities. But recruiting talent for the medical profession is hard enough—salaries are relatively low, as is public respect for doctors. Violence against medical staff is common, often triggered by high prices for their services. Persuading doctors to work in general practice outside hospitals is even tougher. With fewer expensive facilities and medicines at their disposal, community GPs have less opportunity to augment their salaries.
recruit
v. 吸收（新成员）, 征募（新兵）, 动员…（提供帮助）, （通过招募）组成
n. 新兵, 新警员, 新成员
disposal
n. 处理; 解决; 清除; 去掉; 赠送; 转让; 出售; 排列; 布置
政府显然意识到了这个问题。2016年公布的最新医疗改革计划强调了建立有效初级医疗体系的必要性。它已经花费了数十亿美元来加强社区设施。但是为医疗行业招募人才已经够难的了——工资相对较低，公众对医生的尊重也不高。针对医务人员的暴力行为很常见，通常是由他们的服务价格过高引发的。说服医生在医院以外的全科诊所工作更加困难。由于可用的昂贵设施和药品越来越少，社区全科医生增加工资的机会也越来越少。
Neither they, nor doctors in hospitals, have much incentive to make the system work better. Ideally, primary-care facilities should refer people in need of special care to hospitals, which in turn should send patients back for routine follow-up treatment. But referrals can deprive those making them of customers, and doctors are reluctant to lose business. George Liu of La Trobe University in Melbourne notes that the volume of care delivered by community health workers in China has increased in the past decade, but their share of the total has declined. “That’s because they are still competing with hospitals,” he says.
incentive
n. 激励, 刺激, 鼓励
adj. 刺激性的
referral
n. 转送（到能提供专门帮助的人或地方那里），移交；介绍
deprive
v. 剥夺；免职(特指圣职)
无论是他们，还是医院里的医生，都没有太多动力让这个系统更好地运作。理想情况下，初级保健机构应该把需要特殊护理的人转到医院，医院反过来又应该把病人送回去接受常规的后续治疗。但是转诊会让那些为他们提供服务的人失去客户，而医生们不愿意失去生意。墨尔本拉筹伯大学(La Trobe University)的乔治·刘(George Liu)指出，在过去十年里，中国社区卫生工作者提供的医疗服务数量有所增加，但他们所占的份额却有所下降。“这是因为他们仍在与医院竞争，”他说。
As covid cases rise and local governments scramble to beef up primary-care facilities to divert patients from overstretched hospitals, some see a glimmer of hope. On WeChat, Health News, the health ministry’s mouthpiece, said the shift of attention to community clinics had created an “opportunity”. Their fever departments should become a permanent feature, not just a covid-related one, it suggested, so that people with high temperatures would no longer feel a need to go to hospital.
scramble
v. （迅速而吃力地）爬，攀登；匆忙移动；仓促完成（困难的事）；争夺，抢夺；倒换[扰乱]…的频率；打乱
n. 攀爬，爬行；（互相推撞的）争夺，争抢；（因赶任务出现的）忙乱，忙作一团
overstretched
adj. 超出承受能力的
glimmer
n. 微弱的闪光, 闪烁的微光, 微弱的迹象, 一丝
v. 隐约地闪烁, 发出微弱的闪光
随着新冠肺炎病例的增加，地方政府争相加强初级保健设施，以将病人从人满为患的医院转移过来，一些人看到了一线希望。卫生部的喉舌《健康新闻》在微信频道上表示，人们对社区诊所的关注转移创造了一个“机会”。它建议，发烧科应该成为一个永久性的功能，而不仅仅是一个与covid相关的部门，这样高温的人就不会再觉得有必要去医院了。
It is astonishing that China, a country that has hosted two Olympic games and boasts of landing spaceships on the Moon, is still debating how to build community health clinics that patients trust and want to use. If the covid pandemic can accelerate long-needed change, some of the suffering it is causing will not have been in vain. ■
astonishing
adj. 令人十分惊讶的, 使人大为惊奇的, 难以置信的
v. “astonish”的现在分词
vain
adj. 徒劳的, 枉然的, 无结果的, 自负的
令人惊讶的是，中国这样一个举办过两届奥运会，并吹嘘自己的宇宙飞船能登陆月球的国家，却还在讨论如何建立病人信任并愿意使用的社区医疗诊所。如果新冠肺炎大流行能够加速长期需要的变革，那么它造成的一些痛苦将不会是徒劳的。■
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