THE Japane spend half as much on health care as do Americans, but still they live longer. Many give credit to their cheap and universal health insurance system, called kaihoken, which celebrates its 50th anniversary this year. Its virtues are legion. Japane people e doctors twice as often as Europeans and take more life-prolonging and life-enhancing drugs. Rather than being pushed roughly out of hospital beds, they stay three times as long as the rich-world average. Life expectancy has rin from 52 in 1945 to 83 today. The country boasts one of the lowest infant-mortality rates in the world. Yet Japane health-care costs are a mere 8.5% of GDP.
日本人在医疗上的花费只是美国人的一半，却比他们长寿。很多人将其归因于他们价格低廉、覆盖广泛、被称之为kaihoken的医疗系统，今年恰逢此体系建立50周年，其优点不胜枚举。日本人看病的次数是欧洲人的两倍，服用着更为延年益寿的药物。住院治疗时，他们的住院时间是发达国家平均水平的三倍，而出院时并不是被粗鲁地赶出病床。平均寿命从1945年的52岁，上升到如今的83岁。日本是世界上新生儿死亡率较低的几个国家之一，然而医疗支出只占GDP的8.5%。
Even so, the country’s medical system is embattled. Although it needs a growing workforce to pay the bills, Japan is ageing and its population is shrinking. Since kaihoken was established in 1961, the proportion of people over 65 has quadrupled, to 23%; by 2050 it will be two-fifths of a population that will have fallen by 30m, to under 100m. “The Japane health system that had worked in the past has
begun to fail,” Kenji Shibuya of the University of Tokyo and other experts write in a new issue of the Lancet, a British medical journal, devoted to kaihoken. “The system’s inefficiencies could be tolerated in a period of high growth, but not in today’s climate of economic stagnation.”
即使这样，日本的医疗体系也是问题重重。尽管该体系需要日益增加的劳动人群为其买单，日本正经历着人口的锐减和老龄化。自从1961年kaihoken建立至今，65岁以上人口已经增长了三倍，占到总人口的23%；到2050年，65岁以上人口预计达到总人口的五分之二，而那时总人口会减少1000万，不到1亿人口。“过去运转良好的日本医疗体系已经开始衰落，”东京大学的Kenji Shibuya和其他专家在最新一期英国医学杂志，《柳叶刀》，上专门就kaihoken问题发表文章写道，“在过去经济高增长的阶段，还可以承受得起体系的缺陷，而在现今经济停滞的大环境下却不能成行。”
By 2035 health care’s share of GDP will roughly double, according to McKiny, a consultancy. The burden falls on the state, which foots two-thirds of the bills. Politicians are unwilling to rai taxes, so they squeeze suppliers instead: more than three-quarters of publi
c hospitals operate at a loss.
麦肯锡咨询公司估测，到2035年医疗占GDP的比重将会增加一倍。重担落到政府身上，会对三分之二的费用进行买单。政府幕僚不愿意增加税收，于是挤榨药品供应商：超过四分之三的公共医院都处在
盈亏状态。
齐河海底世界Like other rvice industries in Japan, there are cumbersome rules, too many small players and few incentives to improve. Doctors are too few—one-third less than the rich-world average, relative to the population—becau of state quotas. Shortages of doctors are vere in rural areas and in certain specialities, such as surgery, paediatrics and obstetrics. The latter two shortages are blamed on the country’s low birth rate, but practitioners say that they really ari becau income is partly determined by numbers of tests and drugs prescribed, and there are fewer of the for children and pregnant women. Doctors are worked to the bone for relatively low pay (around $125,000 a year at mid-career). One doctor in his 30s says he works more than 100 hours a week. “How can I find time to do rearch? Write an article? Check back on patients?” he asks.
正如日本的其他服务行业，医疗体制中存在着诸多冗杂低效的规章制度，小型机构过多，激励措施稀少。因为国家限定医生人数，医生在总人口所占的比例过低，还不到世界平均水平的三人之一。农村地区医生资源严重不足，而在一些特定领域，如外科、儿科、产科，相关医生也相对稀缺。有人将这两类的匮乏归咎于日本较低的出生率，但医疗从业者声称，原因在于他们的收入部分是由他们给病人所做的检查和所开的药品来决定的，而给儿童和孕妇所做的检查和所开的药品却相对较少。医生们拼命工作，最终得到只是相对较少的工资（一个处在职业中期的医生每年大概收入是125000美元）。一
孜然牛排
位30多岁的医生抱怨他每周工作100个小时。他反问，“我哪儿有时间去搞研究、写论文、回访病人？
On the positive side, patients can nearly always e a doctor within a day. But they must often wait hours for a three-minute consultation. Complicated cas get too little attention. The Japane are only a quarter as likely as the Americans or French to suffer a heart attack, but twice as likely to die if they do.
从积极一面来看，病人在一天之内几乎可以看上医生，但必须等上数个小时，之后才能得到3分钟的会诊。复杂的病情得不到重视。日本人患心脏病的概率仅仅是美国人或法国人的四分之一，倘若患病，死亡的概率却是他们的两倍。
Some doctors e as many as 100 patients a day. Becau their salaries are low, they tend to overprescribe tests and drugs. (Clinics often own their own pharmacies.) They also earn money, hotel-like, by keeping patients in bed. Simple surgery that in the West would involve
no overnight stay, such as a hernia operation, entails a five-day hospital stay in Japan.
起秧子一些医生一天可以看多大一百位病人。因为工资较低，因此他们会开大剂量的药物，给病人做无关紧要的检查。（诊所通常会有自己的药房）。医生们也会想经营旅店一样，按床位来收取费用。在西方国家，比如疝气之类的小手术不会让病人在医院过夜，而在日本却需要住院五天。
搞笑动漫图片
又见晴天
Emergency care is often poor. In lesr cities it is not uncommon for ambulances to crui the streets calling a succession of emergency rooms to find one that can cram in a patient. In a few cas people have died becau of this. One reason for a shortage of emergency care is an abundance of small clinics instead of big hospitals. Doctors prefer them becau they can work less and earn more.
卡通动漫人物图片急诊通常也相对薄弱。在小城市，救护车穿梭于各条街道，一家一家地电话询问附近的急诊室能否收纳一位病人，这很常见。在一些情况下，会因为耽搁时间过长而中途死亡。急诊服务的匮乏一大原因是诊所盛行而大医院相对不足。医生青睐诊所是因为他们在这可少工作而多赚钱。河南省招生考生服务平台
The system is slow to adopt cutting-edge (and therefore costly) treatments. New drugs are approved faster in Indonesia or Turkey, according to the OECD. Few data are collected on how patients respond to treatments. As the Lancet says, prices are heavily regulated but quality is not. This will make it hard for Japan to make medical tourism a pillar of future economic growth, as the government plans.
日本的医疗体制采纳先进（因为先进所以昂贵）疗法的步伐较慢。根据经济合作与发展组织的数据，印尼和土耳其批准新药物的速度要快得多。在日本，很少有人针对病人对疗法的反应采集数据。正如
简爱的英文Lancet中所提到的，价格受到严格监管，而忽略了质量。日本政府计划将医疗旅游业发展为未来经济增长的支柱产业，而对质量的忽视将会令这一计划很难实施。
The Japane are justly proud of their health-care system. People get good basic care and are never bankrupted by medical bills. But kaihoken cannot take all the credit for the longevity of a people who eat less and stay trimmer than the citizens of any other rich country. And without deep cost-cutting and reform, the system will struggle to cope with the coming incredible shrinking of Japan.
日本人对他们的医疗体制引以为豪。人们得到高质量的基本医疗服务，不会因为医疗费用而破产。然而吃得少、身材苗条日本国民的长寿秘诀并不都归因于日本的医疗制度。如果不削减开支、深入改革的话，日本的医疗体制将很难应对即将到来的经济衰退。
