原文标题 :


　　For all they care


　　How hospitals inflate America’s giant health-care bill


　　Non-profit institutions are no help


　　他们不在乎


　　医院如何抬高美国的巨额医疗账单


　　非营利机构帮不上忙


　　[Paragraph 1]


　　WHO IS TO blame for America’s enormous health-care costs?


　　到底谁该为美国巨额的医疗费用负责呢？


　　The sector accounts for almost a fifth of the country’s GDP, twice the average for wealthy countries, yet outcomes are no better.


　　医疗行业几乎占美国GDP的1/5，是富裕国家平均水平的2倍，可医疗成效却未见得更好。


　　Americans under 70 are almost twice as likely as their counterparts in similarly affluent nations to die of cardiovascular diseases.


　　70岁以下的美国人死于心血管疾病的概率，差不多是同等富裕国家民众的2倍。


　　Death rates due to other conditions like diabetes and kidney diseases are also much higher.


　　因糖尿病和肾病等其他疾病导致的死亡率也高得多。


　　[Paragraph 2]


　　Most Americans point the finger at drugmakers, insurers or the middlemen between them.


　　大多数美国人将矛头指向制药公司、保险公司、或是两者之间的中间商。


　　Luigi Mangione, whose trial for the alleged murder of the chief executive of UnitedHealthcare, America’s biggest health insurer, began last month, has received donations totalling $740,000.


　　路易吉·曼吉奥内上个月开始接受审判，他被指控谋杀了美国最大的健康保险公司联合健康集团的CEO。目前，他已收到的捐款总额达74万美元。


　　“He did what everyone else is just thinking,” wrote one sympathiser on Mr Mangione’s fundraising page recently.


　　近日，一名同情者在曼吉奥内的募捐网页上留言称：“他做了别人心里想做却没敢做的事。”


　　[Paragraph 3]


　　More often overlooked are America’s hospitals, which took in $1.5trn in fees in 2023, according to the most recent government figures.


　　根据最新的政府数据，人们经常忽视的是美国医院，2023年美国医院收取的费用达到了1.5万亿美元。


　　That is triple the amount spent on medications, and accounts for a third of America’s total health-care spending (see chart 1).


　　这是药物支出的3倍，占美国医疗总支出的1/3（见图 1）。


　　Since 2000 hospital prices have soared by over 250%, growing at twice the overall rate for medical care and triple the rate of inflation.


　　自2000年以来，医院收费价格飙升了250%以上，是医疗业总体增长率的2倍，是通货膨胀率的3倍。


　　What is behind America’s soaring hospital bills?


　　那么，美国医院费用不断攀升的背后原因是什么呢？


　　[Paragraph 4]


　　Skewed incentives are part of the explanation.


　　不合理的激励机制是其中一个原因。


　　American hospitals primarily operate a “fee-for-service” model, where insurers pay for each test or treatment, regardless of its necessity.


　　美国医院主要采用“按服务收费”模式，在这种模式下，保险公司会为每一项检查或治疗付费，而不考虑是否必要。


　　That encourages them to boost their revenue by delivering as many services as possible.


　　这就使得医院为增加营收而尽可能多地提供服务。


　　America’s government has for years been seeking to shift these incentives, including by aiming to move all beneficiaries of Medicare, the federal health-care programme for the elderly, to “value-based care” arrangements that reward hospitals and clinics for meeting various targets.


　　多年来，美国政府一直致力于改变这些激励机制，其中包括打算让联邦老年人医保计划的所有受益对象都参与到“基于价值的医疗”体系中，这种体系会依据医院和诊所达成的各类目标来给予奖励。


　　But as of 2023, 70% of payments to providers still followed the traditional approach.


　　但截至2023年，支付给医疗服务提供商的费用中仍有70%采用的是传统模式。


　　[Paragraph 5]


　　The problem is compounded by the opacity of hospital pricing.


　　医院定价不公开透明让这个问题愈发严重。


　　The cost of procedures varies widely across hospitals: a study in 2023 by KFF, a health-policy think-tank, found that the sticker price of a colonoscopy in the Atlanta area ranged from $435 to over $7,000.


　　不同医院的手术费用差异极大：健康政策智库凯撒家庭基金会（KFF）2023年的一项研究发现，亚特兰大地区一次结肠镜检查的标价从435美元到超过7000美元不等。


　　But the complexity of medical billing and the nuances of reimbursement often make it difficult to compare services effectively.


　　但由于医疗收费账单错综复杂，以及赔付规则存在的诸多细微差异，人们通常很难对不同医院所提供的服务进行准确有效的比较。


　　[Paragraph 6]


　　Consolidation has made matters worse. Over 1,600 hospital mergers took place between 2000 and 2020.


　　医院的合并让情况变得更糟。 2000-2020年间，共发生了1600多起医院并购案。


　　The share of total hospital beds controlled by chains rose from 58% to 81% over that period.


　　在此期间，连锁医院所掌控的病床数量占比从58%攀升至81%。


　　One or two hospital providers now dominate the market in many American cities (see map).


　　如今，在美国的许多城市，一两家医院供应商占据了市场主导地位（见地图）。


　　HCA Healthcare, the country’s largest chain, operates more than 180 hospitals in America with a total capacity of close to 50,000 beds.


　　美国最大的连锁医院HCA Healthcare在美国运营着180多家医院，总床位接近5万张。


　　[Paragraph 7]


　　Mergers have brought the benefits of scale to the hospital industry, but little of that has been passed on to patients.


　　医院间的合并确实给医院行业带来了规模效益，但患者却几乎没有从中受益。


　　HCA’s return on capital, for example, rose from 10% in 2004 to 15% in 2024.


　　例如，HCA的资本回报率从2004年的10%上升到2024年的15%。


　　Research shows that hospital mergers tend to raise prices for patients with private insurance, without providing better care.


　　研究表明，医院合并往往会提高私人保险患者的医疗价格，但却不会提供更好的医疗服务。


　　Larger hospital chains often use their market power to secure higher prices from insurers.


　　大型医院连锁集团常常会利用自身的市场影响力，从保险公司争取更高的赔付费用。


　　（恭喜读完，本篇英语词汇521/1060左右）


　　原文出自：2025年3月22日《TE》Business版块


　　精读笔记来源于：自由英语之路VIP群本文翻译整理: Irene本文编辑校对: Irene 仅供个人英语学习交流使用。


　　【重点句子】（3个）


　　American hospitals primarily operate a “fee-for-service” model, where insurers pay for each test or treatment, regardless of its necessity.


　　美国医院主要采用“按服务收费”模式，在这种模式下，保险公司会为每一项检查或治疗付费，而不考虑其是否必要。


　　The problem is compounded by the opacity of hospital pricing.


　　医院定价不公开透明让这个问题愈发严重。


　　Research shows that hospital mergers tend to raise prices for patients with private insurance, without providing better care.


　　研究表明，医院合并往往会提高私人保险患者的医疗价格，但却不会提供更好的医疗服务。


　　自由英语之路