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