How doctors can help low-income patients (and still make a profit) | P.J. Parmar

Translator: Ivana Korom Reviewer: Krystian Aparta

翻译人员: jacks peng 校对人员: Danyang Luo

Colfax Avenue, here in Denver, Colorado,

科尔法克斯大道位于科罗拉多州丹佛市，

was once called the longest, wickedest street in America.

曾被称为美国“最长，最邪恶的街道”。

My office is there in the same place -- it's a medical desert.

我的办公室就在那儿—— 那片医疗资源极度匮乏的地区。

There are government clinics and hospitals nearby,

虽然附近有政府诊所和医院，

but they're not enough to handle the poor who live in the area.

但根本不够医治这个地区的穷人。

By poor, I mean those who are on Medicaid.

我所说的穷人是指 那些接受医疗补助的人。

不仅指无家可归的人； 美国有20%的人都接受医疗补助。

Not just for the homeless; 20 percent of this country is on Medicaid.

If your neighbors have a family of four and make less than $33,000 a year,

如果你邻居家有四口人， 年收入不到33,000美元，

then they can get Medicaid.

那么他们就能获得医疗补助。

But they can't find a doctor to see them.

然而他们却找不到医生治病。

A study by Merritt Hawkins

梅里特霍金斯公司做的

found that only 20 percent of the family doctors in Denver

一个研究发现， 丹佛只有20%的家庭医生

take any Medicaid patients.

接受使用医疗补助的病人。

And of those 20 percent, some have caps, like five Medicaid patients a month.

在这20%的医生中，有的有数量限制， 比如一个月看5位医疗补助病人。

Others make Medicaid patients wait months to be seen,

有些医生则让使用医疗补助的 病人等上几个月，

but will see you today, if you have Blue Cross.

但如果你有蓝十字医疗险， 你今天就能接受治疗。

This form of classist discrimination is legal

这种阶级歧视是合法的，

and is not just a problem in Denver.

并且不仅丹佛存在这个问题。

Almost half the family doctors in the country

几乎一半的美国家庭医生

refuse to see Medicaid patients.

都拒绝接收使用医疗补助的病人。

Why?

为什么？

Well, because Medicaid pays less than private insurance

因为医疗补助支付的金额比私人保险低，

and because Medicaid patients are seen as more challenging.

而且人们总觉得接收 使用医疗补助的病人更麻烦。

Some show up late for appointments, some don't speak English

他们有些人会迟到，有些人不会说英语，

and some have trouble following instructions.

有些人在遵循医嘱上也存在困难。

I thought about this while in medical school.

在医学院时我就想过这些问题。

If I could design a practice that caters to low-income folks

如果我能设计出一个适合低收入人群

instead of avoiding them,

而非拒绝他们的医疗模式

then I would have guaranteed customers and very little competition.

那么我的客源就有保证，而且竞争很小。

(Laughter)

（笑声）

So after residency, I opened up shop, doing underserved medicine.

所以在住院医生实习结束后，我开了 一家服务低医疗服务水平人群的诊所。

Not as a nonprofit, but as a private practice.

不是非盈利组织，而是私人诊所。

A small business seeing only resettled refugees.

一个小生意，只为重新安置的难民看病。

That was six years ago,

那是在6年前，

and since then, we've served 50,000 refugee medical visits.

自那之后，我们已经为 5万难民提供了医疗服务。

(Applause)

（鼓掌）

Ninety percent of our patients have Medicaid,

我们的病人中90%有医疗补助，

and most of the rest, we see for free.

对其他剩下的大部分人， 我们提供免费诊疗。

Most doctors say you can't make money on Medicaid,

很多医生说你无法 在使用医疗补助的病人身上赚钱，

but we're doing it just fine.

但我们的收入还不错。

How?

如何做到的呢？

Well, if this were real capitalism, then I wouldn't tell you,

如果这是资本主义，我可不会告诉你，

because you'd become my competition.

因为你们会成为我的竞争对手。

(Laughter)

(笑声)

But I call this "bleeding-heart" capitalism.

但我把这称为“软心肠”的资本主义。

(Laughter)

（笑声）

And we need more people doing this, not less, so here's how.

我们需要更多的人参与进来， 我们是这么做的。

We break down the walls of our medical maze

我们把服务使用医疗补助的病人的

by taking the challenges of Medicaid patients,

挑战转化为机会，

turning them into opportunities, and pocketing the difference.

并从中赚取差价，来解开我们的医疗谜题。

The nuts and bolts may seem simple, but they add up.

螺母和螺栓看起来很简单， 但它们加起来却能发挥巨大的作用。

For example, we have no appointments.

比如，我们无需预约。

We're walk-in only.

我们采取即到即诊的模式。

Of course, that's how it works at the emergency room,

也就是说，急诊室和 塔可钟（墨西哥快餐品牌）

采用了相同的模式。

at urgent cares and at Taco Bell.

(Laughter)

（笑声）

But not usually at family doctor's offices.

但这些在家庭医生的办公室并不常见。

Why do we do it?

我们为什么要这样做？

Because Nasra can't call for an appointment.

因为像纳斯拉这样的人没法预约。

She has a phone, but she doesn't have phone minutes.

她有电话，但她没钱付话费。

She can't speak English, and she can't navigate a phone tree.

她不会说英语，也不会查询通讯录。

And she can't show up on time for an appointment

她无法在预约时间准时出现，

because she doesn't have a car, she takes the bus,

因为她没有私家车，她需要乘坐公车，

and she takes care of three kids plus her disabled father.

并且她需要照顾3个小孩 外加她残疾的父亲。

So we have no appointments;

所以我们不提供预约服务；

she shows up when she wants,

她想来的时候就来，

but usually waits less than 15 minutes to be seen.

通常等待不到15分钟就能就诊。

She then spends as much time with us as she needs.

我们会充分保证她的就诊时长。

Sometimes that's 40 minutes, usually it's less than five.

有时候是40分钟，但通常不到5分钟。

She loves this flexibility.

她喜欢这种弹性。

It's how she saw doctors in Somalia.

她在索马里就是这样看医生的。

And I love it, because I don't pay staff to do scheduling,

这也让我很开心，因为我不需要 额外雇人负责预约事项，

and we have a zero no-show rate and a zero late-show rate.

我们的爽约率和迟到率为零。

(Laughter)

（笑声）

(Applause)

（鼓掌）

It makes business sense.

这很有商业价值。

Another difference is our office layout.

另一个不同是我们办公室的布局。

Our exam rooms open right to the waiting room,

我们的检查室和候诊室相通，

our medical providers room their own patients,

每个医生都和他们自己的 病人独享一个房间，

and our providers stay in one room instead of alternating between rooms.

我们的服务人员集中在一个房间里， 而不需要在两个房间之间来回穿梭。

Cutting steps cuts costs and increases customer satisfaction.

削减流程降低了成本，提高了客户满意度。

We also hand out free medicines, right from our exam room:

我们还在诊室分发免费药品：

over-the-counter ones and some prescription ones, too.

非处方药和一些处方药。

If Nasra's baby is sick,

如果纳斯拉的孩子病了，

we put a bottle of children's Tylenol or amoxicillin right in her hand.

我们会直接给她一瓶 儿童泰诺或阿莫西林。

She can take that baby straight back home instead of stopping at the pharmacy.

她可以直接带孩子回家， 而无需再去药店。

I don't know about you, but I get sick just looking at all those choices.

我不知道你们怎么想， 但我一见到这一大堆药就头晕。

Nasra doesn't stand a chance in there.

纳斯拉根本没法在这里买药。

We also text patients.

我们也给病人发短信。

We're open evenings and weekends.

我们晚上和周末都营业。

We do home visits.

我们做家访。

We've jumped dead car batteries.

我们把汽车电池都跑到没电了。

(Laughter)

（笑声）

With customer satisfaction so high, we've never had to advertise,

有这么高的客户满意度， 我们根本不用打广告，

yet are growing at 25 percent a year.

还能以每年25%的速度增长。

And we've become real good at working with Medicaid,

我们变得很熟悉Medicaid的业务，

since it's pretty much the only insurance company we deal with.

因为它几乎是我们 唯一合作的保险公司。

Other doctor's offices chase 10 insurance companies

其他医生的诊所同时 与10家保险公司合作

just to make ends meet.

以实现收支平衡，

That's just draining.

但收效甚微。

A single-payer system is like monogamy: it just works better.

单一支付方制度就像一夫一妻制: 它就是效果更好。

(Laughter)

（笑声）

(Applause)

（鼓掌）

Of course, Medicaid is funded by tax payers like you,

当然，医疗补助计划由像 你们这样的纳税人资助，

so you might be wondering, "How much does this cost the system?"

所以你们可能会好奇， “这个系统要花多少钱？”

Well, we're cheaper than the alternatives.

我们比主流方案便宜。

Some of our patients might go to the emergency room,

我们有些病人去急诊室，

which can cost thousands, just for a simple cold.

仅仅一个简单的感冒， 就要花数千美元。

Some may stay home and let their problems get worse.

有些人则呆在家中，坐等问题恶化。

But most would try to make an appointment at a clinic that's part of the system

但是大多数人会尝试在 属于联邦授权医疗中心的

called the Federally Qualified Health Centers.

一个诊所预约。

This is a nationwide network of safety-net clinics

这是一个覆盖全国的诊所安全网络，

that receive twice as much government funding per visit

每次看病得到的政府资助

than private doctors like me.

是像我这样的私人医生的两倍。

Not only they get more money,

他们不仅收取更高的费用，

根据法律，每个地区只能有一个。

but by law, there can only be one in each area.

That means they have a monopoly on special funding for the poor.

这意味着他们垄断了为穷人 提供的特殊资金。

And like any monopoly,

跟任何垄断一样，

there's a tendency for cost to go up and quality to go down.

总是成本会上升，质量会下降。

I'm not a government entity; I'm not a nonprofit.

我不是政府实体，我不是非盈利组织。

I'm a private practice.

我是个私人诊所。

I have a capitalist drive to innovate.

我有资本主义的创新动力。

I have to be fast and friendly.

我必须高效和友好。

I have to be cost-effective and culturally sensitive.

我得有成本效益和文化敏感性。

I have to be tall, dark and handsome.

我必须又高又黑又帅。

(Laughter)

（笑声）

(Applause)

（鼓掌）

And if I'm not, I'm going out of business.

如果不具备这些，我的生意就会垮掉。

I can innovate faster than a nonprofit,

我比非盈利组织在创新方面更高效，

because I don't need a meeting to move a stapler.

因为我不需要开个会 来决定是否拆除缝合器。

(Applause)

（鼓掌）

Really, none of our innovations are new or unique --

我们的创新都不是新的或独创的——

we just put them together in a unique way

我们只是用一种独特的方法 把它们组合在一起，

to help low-income folks while making money.

在帮助低收入人群的同时还赚钱。

And then, instead of taking that money home,

然后，我会把这些钱投入难民社区

I put it back into the refugee community as a business expense.

作为商业支出，而不是拿回家。

This is Mango House.

这是芒果屋。

My version of a medical home.

我创建的医疗之家。

In it, we have programs to feed and clothe the poor,

在那里，我们为穷人提供食物和衣服，

an after-school program, English classes,

提供课外项目，英语课，

churches, dentist, legal help, mental health and the scout groups.

教堂，牙医，法律援助， 心理辅导和童子军等项目。

These programs are run by tenant organizations

这些项目由承租组织

and amazing staff,

和出色的员工运作，

but all receive some amount of funding form profits from my clinic.

但他们都从我的诊所获得了一些资金。

Some call this social entrepreneurship.

有人称之为社会企业家精神。

I call it social-service arbitrage.

我称之为社会服务套利。

Exploiting inefficiencies in our health care system to serve the poor.

利用我们卫生保健系统的 低效率为穷人服务。

We're serving 15,000 refugees a year

我们每年服务15,000位难民，

at less cost than where else they would be going.

且比其他地方花费更少。

Of course, there's downsides to doing this as a private business,

当然，作为私人企业， 既非非盈利组织，也非政府实体，

做这个也有不利的一面。

rather than as a nonprofit or a government entity.

There's taxes and legal exposures.

有税收和法律风险。

There's changing Medicaid rates and specialists who don't take Medicaid.

有不断变化的医疗补助率和 不接受医疗补助病人的专家。

And there's bomb threats.

还有炸弹威胁。

Notice there's no apostrophes, it's like,

请注意，这里少了个标点符号， 所以表达的意思就变成了，

"We were going to blow up all you refugees!"

“我们本来要炸掉你们这些难民！”

(Laughter)

（笑声）

"We were going to blow up all you refugees,

“我们本来要炸掉你们这些难民，

但后来我们去上了你们的英语课。”

but then we went to your English class, instead."

(Laughter)

（笑声）

（鼓掌）

(Applause)

Now, you might be thinking, "This guy's a bit different."

现在，你可能在想， “这家伙的确有一套。”

(Laughter)

（笑声）

Uncommon.

罕见。

(Laughter)

（笑声）

A communal narcissist?

一个公共自恋者？

(Laughter)

（笑声）

A unicorn, maybe,

也许还是独角兽，

because if this was so easy, then other doctors would be doing it.

但如果这么简单的话， 其他医生也会这样做。

Well, based on Medicaid rates, you can do this in most of the country.

根据医疗补助率，你可以在 全国大部分地区这样做。

You can be your own boss,

你可以做自己的老板，

help the poor and make good money doing it.

帮助穷人并赚大钱。

Medical folks,

医学院的人

you wrote on your school application essays

可能在申请学校时说过

that you wanted to help those less fortunate.

你想帮助那些不幸的人。

But then you had your idealism beaten out of you in training.

但你的理想情怀在训练过程中丢掉了。

Your creativity bred out of you.

你的创造力不复存在了。

It doesn't have to be that way.

你们本可以做得更好。

You can choose underserved medicine as a lifestyle specialty.

你可以选择医疗服务不足的 领域作为毕生专业。

Or you can be a specialist

或者你可以选择成为

who cuts cost in order to see low-income folks.

降低成本，为低收入人群看病的专家。

And for the rest of you, who don't work in health care,

对不从事医疗保健行业的其他人来讲，

你的申请表是怎么写的？

what did you write on your applications?

Most of us wanted to save the world, to make a difference.

我们大部分人想要 拯救世界，改变现状。

Maybe you've been successful in your career

你们也许在你们的职业中已足够成功，

but are now looking for that meaning?

现在正在寻找生活的意义？

How can you get there?

你如何能够实现那个目标？

I don't just mean giving a few dollars or a few hours;

我指的不是捐献一些钱或几个小时；

I mean how can you use your expertise to innovate new ways of serving others.

我的意思是你如何使用你的专业技能， 以新的方式去服务他人？

It might be easier than you think.

这可能没你想的那么难。

The only way we're going to bridge the underserved medicine gap

我们能够弥补医疗服务不足的唯一方法

is by seeing it as a business opportunity.

是将其视为商业机会。

The only way we're going to bridge the inequality gap

我们缩小不平等差距的唯一途径

is by recognizing our privileges and using them to help others.

是认识到我们的特权， 并利用这些特权帮助他人。

(Applause)

（鼓掌）