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乡村医院持续倒闭,美国的国家安全网医院也不安全了

2020-09-28 00:00:33健康界
核心提示:2020年8月的一个早晨,维克多·科罗纳多想站起来倒杯茶,就在站起来的刹那,他感觉头晕目眩,右侧身体突然变沉,而且说话口齿不清。他回忆说:“那时我感到自己中风快要发作了。”

  2020NIAN8YUEDEYIGEZAOCHEN,WEIKEDUO·KELUONADUOXIANGZHANQILAIDAOBEICHA,JIUZAIZHANQILAIDECHANEI,TAGANJUETOUYUNMUXUAN,YOUCESHENTITURANBIANCHEN,ERQIESHUOHUAKOUCHIBUQING。TAHUIYISHUO:“NEISHIWOGANDAOZIJIZHONGFENGKUAIYAOFAZUOLE。”

  KELUONADUOBEIJINJISONGWANGLIJIAZUIJINDEYIYUAN——ZHIJIAGENANQUDEZHIJIAGECISHANYIYUANYILIAOZHONGXIN(Mercy Hospital & Medical Center)。YISHENGJIANGYAOWUZHURUTADEJINGMAI,JISHIQINGCHULEYIJINRUDANAODEXUEKUAI。

  KELUONADUODEDAOJISHIJIUZHI,ZHUANWEIWEIAN,DANJIUTADEYIYUANQUEBINLINDAOBI。

  岌岌可危的处境

  GUOQU20NIAN,MEIGUOXIANGCUNYIYUANYIZHICHUYUJIASUDAOBIDEZHUANGTAI,ERXIANZAI,YINWEIXINGUANFEIYANYIQING,WEIYUCHENGSHIDEGUOJIAANQUANWANG(BIANZHEZHU:MEIGUOZHUANMENFUZEDUIDISHOURU、MEIYOUCANJIAYILIAOBAOXIANYIJIRUOSHIRENKOUTIGONGYILIAOFUWUDEYIYUAN)YIYUANYEMIANLINZHETONGYANGDEMINGYUN。

  ZHIJIAGEYOUSANJIAGONGLIYIYUAN,DANDABUFENDISHOURUHUANZHEYOUZHIJIAGECISHANYIYUANYILIAOZHONGXINDENGANQUANWANGYIYUANFUWU。

  ZHEILEIYIYUANLIHUANZHEJIAHENJIN,SHENGYULIANGHAO,ERQIEHAIWEISHAOSHEQUJUMINTIGONGJIUYEJIHUI,YINCIYIZHISHIDANGDIJUMINDE。

  ZHIJIAGECISHANYIYUANYILIAOZHONGXINCHENGLIYU168NIANQIAN,SHIZHIJIAGEDIYIJIACHENGSHIYIYUAN。JINGUANZAI1871NIANDEZHIJIAGEDAHUOZHONG“XINGCUN”XIALAI,DANMIANDUIYIQINGDEYINGXIANG,ZHEIJIAYIYUANQUEBUDEBUBAIXIAZHENLAI。YOUYUMUQIANMIANLINZIJINBUZUWENTI,WUFAJIXUWEIQIONGRENTIGONGFUWU,2020NIAN7YUE,ZHEIJIAYONGYOU412ZHANGCHUANGWEIDEYIYUANTONGZHIZHOUJIANGUANJIGOU,JIHUAZUIKUAIZAI2021NIAN2YUEGUANBIQISUOYOUZHUYUANFUWU。

  ZAIZHIJIAGEXICHENGDEJIAOXUEYIYUANLASHENDAXUEYIXUEZHONGXIN(Rush University Medical Center)FUZESHEQUWEISHENGDEGAOJIFUZONGCAIDAWEI·ANSAIERBIAOSHI,“ZHIJIAGECISHANYIYUANYILIAOZHONGXINYIDANDAOBI,QIZHOUWEIYUE7YINGLI(YUE11GONGLI)FANWEINEIJIANGMEIYOURENHEYIYUAN,ZHEIXIANGDANGYUZAIZHIJIAGENANQUXINGCHENGYIGEYILIAOSHAMO。”

  ZHIJIAGECISHANYIYUANYILIAOZHONGXINCIQIANFABUDEYIFENPINGGUBAOGAOXIANSHI,QIFUWUFANWEINEIJUZHUZHE55%DEPINKUNRENKOUHE62%DEFEIYIMEIGUOJUMIN。RUGUOYIYUANGUANBI,DANGDIJUMINKAICHEQULIZHIJIAGECISHANYIYUANYILIAOZHONGXINZUIJINDEYIYUANKENENGXUYAO15FENZHONGJIYISHANG,ERDANGDIXUDUOJUMINMEIYOUQICHE。

  ZAI2020NIAN7YUEZHIQIAN,MAYA·LUOERFUYIZHISHIZHIJIAGECISHANYIYUANYILIAOZHONGXINDEZHUYUANYISHI。TABIAOSHI,GAIYIYUANDEFUWUDUIXIANGHENDUOSHIGAOWEINVXING,YIYUANFUCHANKEDEGUANBIJIANGDUITAMENZAOCHENGSHIZHIXINGDESHANGHAI。

  ANSAIERBIAOSHI:“GUOQUYINIANZUOYOU,ZHIJIAGEYIDAOBILESANJIAYIYUAN,BINGQIEDOUWEIYUHEIRENSHEQU。ZAIWOKANLAI,GUANBIZHIJIAGECISHANYIYUANYILIAOZHONGXINBIYOURENYINCIERSIWANG,ZHEIWUYIYUFANZUI。”

  ZAOZAI2019NIAN,MEIGUOLIANGJIAANQUANWANGYIYUANYEZOUSHANGLEDAOBIZHILU。TAMENFENBIESHIFEICHENGDEHANIMANDAXUEYIYUAN(Hahnemann University Hospital)HEHUASHENGDUNDEPULUOWEIDENGSIYIYUAN(Providence Hospital)。LINGWAI,HUASHENGDUNWEIYIYIJIAGONGLIYIYUAN,WEIYUHUASHENGDUNZUIPINKUNDIQUDELIANHEZHENLIAOZHONGXIN(United Medical Center)YEJIHUAZAI2023NIANGUANBIQIZHUYUANFUWU。

  WAIMEIBAODAO,MEIGUOANQUANWANGYIYUANDEDAOBISUDUSUIMEIYOUXIANGCUNYIYUANNEIMEPINFAN,DANBUFENRENGZAIYINGYEDEYIYUANWEILAIKENENGHUIXUEJIANYIXIEZHUANYEFUWU,RUFENMIANFUWUHECHUANGSHANGHULI。ZHEIJIANGDAOZHIJISHIZAIJINJIQINGKUANGXIA,HUANZHEYEBIXUQULIJIAHENYUANDEYIYUANJIUYI。

  濒临倒闭的原因

  SHISHISHANG,MEIGUOGUOJIAANQUANWANGYIYUANXIANRUKUNJINGDEJIEJUBUKEBIMIAN。

  DIYI,HUANZHEWUFAZHIFUYILIAOFEI。ZHEIXIEYIYUANZHILIAODEDABUFENHUANZHEDOUMEIYOUMAIBAOXIAN,WUFAZHIFUYILIAOZHANGDAN。JINGUANYOUXIEHUANZHEXIANGSHOUYILIAOBUZHU(Medicaid),DANRENGNANYIZHIFU。

  DIER,QITASIYINGYIYUANJINGZHENGLIGENGQIANG。YUQITASIYINGYIYUANXIANGBI,CHENGSHIANQUANWANGYIYUANDECHUJINGGENGJIAJIANNAN。YINWEIQITASIYINGYIYUANWANGWANGGENGJIAXIANJIN,XUDUOYONGYOUBAOXIAN,ERYOUNENGLIZHIFUYILIAOFEIYONGDEHUANZHEGENGYUANYIXUANZEZHEIXIEYIYUAN,ERBUSHIANQUANWANGYIYUAN。

  DISAN,XINGUANFEIYANYIQINGYANZHONGYINGXIANGYIYUANDEHEXINHUANZHE。ZAIZHIJIAGEDENGDACHENGSHILI,QIONGRENHEYOUSERENZHONGSHIZHEILEIYIYUANDEHEXINHUANZHE,TONGSHI,TAMENYESHISHOUDAOXINGUANFEIYANYIQINGYINGXIANGZUIWEIYANZHONGDERENQUN。YINCI,ZAIXINGUANFEIYANYIQINGQIJIAN,ANQUANWANGYIYUANDEZERENGENGJIAZHONGDADETONGSHI,CAIWUWEIJIYEYUJIAYANZHONG。

  努力自救却无果

  HAFOCHENCENGXIGONGGONGWEISHENGXUEYUAN(Harvard T.H. Chan School of Public Health)JIANZHIJIAOSHOUNANXI·KAIENCONG2010NIANJIUKAISHIYANJIUMEIGUOCHENGSHIGUOJIAANQUANWANGYIYUANDEJINGKUANG。TABIAOSHI,“JIBIANYOUXIEYIYUANDAOBILE,DANDADUOSHUYIYUANDOUHUIXUANZENULIJINRUYIGEGENGDADETIXI,ZHENGQUZAIJIANCHIJINIAN,YIZHIDAODANGJUGUANBITAMEN。”

  20SHIJI,MEIGUODADUOSHUCHENGSHIZHENGFUDOUJINGYINGZHEYIJIAGONGLIYIYUAN,YIFUWUDANGDIPINKUNRENKOU。HOULAI,MEIGUODEZHENGFUYIBAO——YILIAOBAOXIAN(Medicare)HEYILIAOBUTIE(Medicaid)CHUXIANHOU,JIASHANGYILIAOFEIYONGDEBUDUANSHANGZHANG,DIFANGZHENGFUDEJINGJIYUSUANBUKANZHONGFU,POSHIXUDUOSHIZHENGFUFANGQIJINGYINGGONGLIYIYUAN。XIANRUJIN,QUANMEI5230JIAZONGHEYIYUANZHONG,ZHIYOU498JIASHUYUGONGLIYIYUAN。

  JINNIANLAI,MEIGUOYIXIEYILIAOJIGOUJIANGANQUANWANGYIYUANMAIJILEMOUXIEQIYE,ERQIYEYEWUFAWEICHIYIYUANDEYUNYING。

  2018NIAN,MEIGUOYIJIAYINGLIXINGZHIDELIANSUOYIYUAN——TAINITEYILIAO(Tenet Healthcare Corp.),JIANGHANIMANDAXUEYIYUANYI1.7YIMEIYUANDEJIAGECHUSHOUJIJIAZHOUSIMUGUQUANTOUZIZHEQIAOER·FULIDEMAN。YINIANHOU,FULIDEMANXUANCHENGZIJIYIWUFACHENGDANYIYUANDEKUISUN,SHENQINGPOCHAN。TONGSHI,TAJIANGYIYUANMINGXIABAOKUOSHITIJIANZHUZAINEIDEFANGDICHANJINXINGFENLI,ZHUANYIDAOLINGYIJIAGONGSIMINGXIA,FANGBIANQIZAICICHUSHOUJIFANGDICHANKAIFASHANG。

  WEIYUZHIJIAGEXIJIAOQUYILINUOYIZHOUDEMEIERLUOSIGONGYUANDEXIHUYIYUAN(Westlake Hospital)YESHUYUMEIGUOGUOJIAANQUANWANGYIYUAN。2018NIAN,TAINITEYILIAOJIANGQICHUSHOUJIYIJIASIRENTOUZIGONGSI。JINCHUSHOULIANGZHOUHOU,GAIGONGSIJIUXUANBUGUANBIYIYUAN。MEIERLUOSIGONGYUANQISUYIYUANYUANSHUJIGOU,ZHIKONGTAMENZAICHUSHOUQIANSHENGCHENGHUIJIXUYINGYE,WUDAOLEDANGDIGUANYUAN。ZUIZHONG,YIYUANYUANSHUJIGOUXIANGMEIERLUOSIGONGYUANPEIFU150WANMEIYUAN。

  SUIRANZHEIXIEYIYUANCHUJINGSHIFENJIANNAN,DANRENGYOUBUFENYIYUANHAIZAINULIZIJIU。

  GELUNBIYATEQUXIWANGJISHIZHISUN,YUSHIJIANGLIANHEZHENLIAOZHONGXINDEGUANLIQUANWAIBAOJILEDUOJIASIRENZIXUNGONGSI。DANZHEIYIJUDONGBUJINMEIYOURANGYIYUANNIUKUIWEIYING,ERQIEHAIXUESHANGJIASHUANG。QIZHONGYIJIAGONGSIBEIZHIKONGLANYONGNASHUIRENDEZIJIN,HAIFASHENGLEYILIANCHUANYANZHONGDEHUANZHEANQUANSHIJIAN,QIZHONGBAOKUOFUCHANKEBINGFANGDEWEIGUIXINGWEI。2017NIAN,GELUNBIYATEQUBEIPOGUANBIGAIBINGFANG。

  HUANQIUJIANKANGFUWUGONGSI(Universal Health Services)SHIMEIGUO500QIANGQIYE,YONGYOU400JIAYIYUAN,CAIZHENGSHOURUDA110YIMEIYUAN。JINNIANZAOXIESHIHOU,GELUNBIYATEQUYUGAIGONGSIDACHENGXIEYI,YOUGAIGONGSIYUNYINGYIJIAXINYIYUAN。YUYUANLAIDELIANHEZHENLIAOZHONGXINXIANGBI,XINYIYUANDECHUANGWEIJIANGJIANSHAOSANFENZHIYI。CIWAI,HUANQIUJIANKANGFUWUGONGSIHAIYUQIAOZHI·HUASHENGDUNDAXUE(George Washington University)HEZUOJINGYINGQIAOZHI·HUASHENGDUNDAXUEYIYUAN(George Washington University Hospital)。JINGUANZHEIZHONGHEZUOGUANXIYIZHICUNZAIZHENGYI——2019NIAN,QIAOZHI·HUASHENGDUNDAXUEZHIKONGGAIGONGSINUOYONGLEBENYINGLIUZAIYILIAOXITONGDE1YIMEIYUAN。2020NIAN6YUE,FAGUANBOHUILEQIAOZHI·HUASHENGDUNDAXUEDEDABUFENSHENSU。

  LUOERFUBIAOSHI,“MINZHONGWANGWANGGENGQINGXIANGYUBAQIANFANGZAITAMENXIANGFANGDEDIFANG。”YIGECHENGSHIMOUXIESHEQUDEZHONGYAOYIYUANJIJIANGDAOBI,ERZHEIZUOCHENGSHIQUERENGZAIHUAFEIDABIZIJINMEIHUASHIZHONGXIN。ZHEIYIWEIZHE,ZAIZHEIZUOCHENGSHIYANLI,ZHEIXIESHEQUDEHUANZHEBURUQITASHEQUDEHUANZHELAIDEZHONGYAO。

  YUANWENLAIYUAN:KHN

  YUANWENBIAOTI:Urban Hospitals of Last Resort Cling to Life in Time of COVID

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