2022考研英語閱讀：遇冷的醫(yī)改

#/72022考研英語閱讀：遇冷的醫(yī)改WITHtheConservativestherewillbenomoreofthetiresome,meddlesome,top-downrestructuresthathavedominatedthelastdecadeoftheNHS.SosaidDavidCameronin2022,andmanywereconvinced.VotersmadeMrCameronprimeministerin2022inpartbecausetheConservativePartycutintoLabour'sleadonhealthcare,whichithadenjoyedalmostsinceitfoundedtheNHSin1948.TheToriesquicklysquanderedtheiradvantage.Buttheirlegacywillbebetterthantheyseemtobelieve.有了保守黨，NHS（NationalHealthService英國國民健康保險制度）近十年主要的惱人、好事、專制的醫(yī)療結(jié)構(gòu)會一掃而光，這是英國首相卡梅倫在2022年說過的話，且廣受信服。2022年，選民把戴維卡梅倫選為首相，有部分原因是因為保守黨插手了工黨主導(dǎo)的醫(yī)療保健項目，這個項目幾乎自從1948年設(shè)立了NHS就贊譽頗多。然而保守黨很快就把優(yōu)勢糟蹋一空。但遺產(chǎn)比他們大部分人認為的要豐厚。Inspiteofhispromise,MrCameron'sConservative-LiberalDemocratcoalitiongovernmentembarkedonreformsthatwouldreshapetheNHSfromthetopdown.TheimmenseHealthandSocialCareActof2022increasedcompetition,gavetheservicegreaterautonomyandputmoredecisionsaboutthepurchaseofcareinthehandsoflocaldoctors,knowninBritainasgeneralpractitioners,orGPs.Thechangesweresobigthattheycouldbeseenfromspace,quippedSirDavidNicholson,thedepartingheadoftheNHS.即便是承諾在前，卡梅倫領(lǐng)導(dǎo)的保守黨和自由民主黨聯(lián)合政府著意的改革仍將自上而下的改造NHS。2022年，聲勢浩大的醫(yī)療社會保障法案使競爭更加激烈，給醫(yī)療服務(wù)業(yè)更大的自主權(quán)，以及把決定醫(yī)療開銷的權(quán)利交由本地醫(yī)生掌握，這類醫(yī)生在英國被稱為全科醫(yī)生，簡稱全醫(yī)。NHS前主管戴維尼克爾森爵士曾調(diào)侃，這么大的變革，在太空都能看到。Thegovernmentsooncametowishtheywoulddisappear.Thereformswereneverpopularwithabemusedpublic.Doctors'groupsarguedtheywouldleadtoamorefragmentedandprivatisedsystem.OthersworriedthatGPswouldbeincapableofcommissioningcare.EdMiliband,Labour'sleader,dubbedthereformsMrCameron'spolltax,areferencetothepolicythathelpedfellMargaretThatcher.InthiscaseitwasAndrewLansley,thehealthsecretary,whofell.Lessthansixmonthsafterhisreformswerepassed,MrLansleywasreplacedbyJeremyHunt,whotalksaboutthemaslittleaspossible.很快，政府就希望這些變革能盡快消失。迷惑的民眾并不歡迎這些改革。醫(yī)生群體稱，這個權(quán)利會讓他們最終導(dǎo)致一個更加零碎化、私有化的醫(yī)療系統(tǒng)。還有人擔(dān)心，全科醫(yī)生并沒有能力被委任護理。工黨領(lǐng)袖埃德米利班德把這些改革戲稱為卡梅倫的人頭稅，一個曾經(jīng)讓撒切爾夫人下臺的參考政策。而現(xiàn)在，下臺的是衛(wèi)生部長安德魯蘭斯。蘭斯的改革通過不到六個月內(nèi)，他就被杰里米亨特代替了，而后者幾乎對改革只字不談。ThehealthreformsweresupposedtomaketheNHSmoreindependent.YetMrHuntnowstyleshimselfapatients'championheisknowntoringhospitalstoaskaboutwaitingtimes.Thisisaconcessiontoreality:politicianswillalwaysbeheldaccountablefortheperformanceoftheNHS.Still,thefranticsmotheringofthereformsconcealssomethinguseful.Apolicythathascausedthegovernmentsomuchembarrassmentisquietlybearingfruit.醫(yī)療改革旨在讓NHS更加獨立。然而杰里米亨特現(xiàn)在自比為病人的勝利，因為大家都知道他常常打電話給醫(yī)院詢問等待時間。這是承認現(xiàn)實：政客永遠要為NHS的表現(xiàn)負責(zé)。但是，改革密不透風(fēng)的大動干戈掩蓋了一些有用的東西。一個讓政府非常窘迫的政策正靜悄悄地開花結(jié)果。Let211flowersbloom讓211之花盛開Thebiggestchangewasthecreationof211ClinicalCommissioningGroups(CCGs),whichplacedabout60%oftheNHSbudgetinthehandsoflocaldoctorsandhealthworkers.Theybecameresponsibleforprocuringhospitalcare,mental-healthservicesandthelike.Navigatingamuddledsystem,thecannieroneshavefiguredoutwaystorealigntheincentivesofhospitals,whichareoftenpaidperprocedure,withthoseofGPs,whoaimtokeeppeoplehealthyandathome.最大的改變是2n臨床調(diào)試組(CCGs)這一創(chuàng)舉，收納了本地醫(yī)生和醫(yī)務(wù)人員手中60%的NHS預(yù)算。調(diào)試組負責(zé)采購醫(yī)院護理、心理健康護理之類的物品。游走在混亂的醫(yī)療系統(tǒng)中，頭腦靈活的人已經(jīng)想出辦法調(diào)整對醫(yī)院的刺激，這些在每次采購中都會被全科醫(yī)生償付，他們旨在使病人保持健康，覺得自在。ThecommissioninggroupinBedfordshire,forexample,hasbundledsome20contractsformusculoskeletalcare（treatmentforthingslikeweakkneesandcrackedhips）intoonefive-yearcontractthatwaswonbyCircle,acommercialhealthgroup.Farfromfragmentingthesystem,ascriticshadfeared,thishasmadeCircleresponsibleforintegratingtheservicesoflocalproviders.Patientswillbetoldwhicharedoingbest.Circleanditspartnersmustachieveanagreedsetofoutcomestoreceivesomeoftheirpay.PaoloPieri,Circle'schieffinancialofficer,expectsthedealwillnotonlyimprovecarebutsaveBedfordshiresome￡30m（$50m）.例如英格蘭南部貝德福德郡的調(diào)試組，已把20余份關(guān)于肌肉骨骼保?。嫦虼嗳醯捏x骨和股骨骨折之類的治療）的合同與一份五年期的合同相捆綁，這份合同被商業(yè)醫(yī)療集團Circle中標(biāo)。批評家們曾經(jīng)擔(dān)心的醫(yī)療系統(tǒng)會分崩離析的問題使Circle必須負責(zé)，這能使Circle為本地供應(yīng)商的集成服務(wù)負責(zé)。病人將會被告知哪個做的最好。Circle及其合伙人必須就后果及分利達成共識。Circle的CFO（首席財政官）保羅皮耶里希望，這筆交易不僅僅能夠改善衛(wèi)生保健，還能為貝德福德郡留下約3000萬英鎊（約合5000萬美元）的結(jié)余。Notallcommissioninggroupsareasbold.ButperhapsaquarterareconsideringcontractsliketheoneinBedfordshire,reckonsMrPieri.DianeBell,adoctorthere,saysmorethan40CCGshavecontactedhergroup.EveryCCGIlookatisdoingbraveandinnovativework,saysShaneGordon,whoheadsoneinEssex.并非所有調(diào)試組都能這般大膽無畏。皮耶里推測，約有四分之一的調(diào)試組正考慮像貝德福德郡那個一樣簽訂合同。貝德福德郡的一位醫(yī)生戴安娜貝爾說，有超過40家臨床調(diào)試組與她的團隊簽訂了合同。肖恩戈登在埃塞克斯郡領(lǐng)導(dǎo)一個調(diào)試組，他說每個臨床調(diào)試組在我看來都在從事勇敢無謂、富于創(chuàng)新的工作。TheLabourPartywhichlaunchedaseriesofNHSreformsduringits13yearsinpowersaysthissortofinnovationwasonthewayanyway,andmayhavebeendelayed.ThankstothegiantrestructuringoftheNHSwelosttwoorthreeyears,saysAndyBurnham,theshadowhealthsecretary.Healsocriticisesaregulatoryregimethatleavesmanyprovidersconfused.Fairenough.Butthereformsreplacedbureaucratswithclinicians,whichseemstohaveencouragedcreativethinking.DrBellwaswarnedbyanoldhandthatoutcomes-basedcontractingwouldstirupafightinhergroup.Whenshesuggestedit,though,theotherGPsquicklyboughtin.工黨在其執(zhí)政的13年間，曾頒布了一系列NHS改革，它稱這類改革創(chuàng)新不管怎么說都已經(jīng)在半路上了，還有可能推遲。影子衛(wèi)生部長安迪博翰諷刺，幸虧這次NHS巨大的改革讓我們浪費兩三年。他還批評監(jiān)管制度讓許多供應(yīng)商迷惑不解。雖有道理，但是改革用臨床醫(yī)生代替了官僚分子，似乎還鼓勵了創(chuàng)造性思維。貝爾醫(yī)生曾被這行老手告誡這個以結(jié)果為基礎(chǔ)的契約簽訂可能引起團隊內(nèi)訌。盡管當(dāng)她提到了這個，全科醫(yī)生還是被迅速引入了。IfLabourwinsthenextelection,MrMilibandmightgroundCCGsjustastheyaretakingflight.AlthoughhehasnoplanstorestructuretheNHSyetagain,hislaudableaimofintegratinghealthandsocialcare,whichcurrentlyfallsoutsidetheNHS'sremit,wouldprobablyshiftresponsibilitytoadifferentlocalbody.MrBurnhamwouldalsoclipthewingsofreformersbygivingNHSprovidersabuilt-inadvantageinthecompetitionforcontracts.下屆大選如果工黨獲勝，米利班德可能擱置臨床調(diào)試組，正如現(xiàn)在他們才剛剛起航。即使他沒有再次重組NHS的計劃，他值得贊賞的集成醫(yī)療社會保障計劃目前還處于NHS的推遲項目，很可能把責(zé)任轉(zhuǎn)移到一個不同的地方機構(gòu)。博翰也會通過給予NHS供應(yīng)商先天優(yōu)勢的方式，限制改革者在簽訂合同方面的競爭。ButthebiggestthreattoCCGsandwhatsomeofthemaredoingtoimproveservicesisnotpoliticsbutwhethertheycanmovefastenoughtokeepinfrontofafundingsqueeze,saysThomasCawstonofReform,athink-tank.ThoughtheNHShasbeenprote