文、译/林巍

China’s medical reform carried out in recent years has generally been seen as a failure, evidenced in the difficulty of getting medical services, high drug prices, the tension-ridden doctor-patient relationship and so on. Some experts said that all this is attributable to insuf ficient marketization. I think, however, there are many more reasons than this.

[2] When I returned to China after living overseas for more than a decade,it was strange to see the media being flooded by advertisements for various medicines and medical equipment,strikingly different from practice in the West, where doctors provide prescrip-tions for patients to obtain their medicines from pharmacies whose commercial operation has nothing to do with doctors. Chinese doctors, in addition to their routine duties, have to shoulder the task of “drug-provisioning-medicine”to cover the hospital expenses and to ensure wage-raises. This is completely wrong in my opinion.

[3] A doctor’s bounden duty is to treat patients and save lives, which is fundamentally in line with the patients’ desire.Doctors’ rewards and achievability are obtained solely from the effectiveness of their treatment; any other factors intruding into this process will inevitably change the nature of the profession.

[4] Unlike other physical sciences,medicine involves people relations and is seen as a special social culture. The reason for the tense relations between doctors and patients, according to some specialists, lies in the disproportion of doctors to patients, since in many hospitals doctors have to treat several dozens or even more patients every day. While this may be one of the factors, the root cause, in my view, is the patients’ dis-trust of their doctors, who are deemed not to aim at healing them but rather at generating pro fits.

[5] Patients are in an extremely vulnerable position to be ripped off since doctor-patient relations, very much like those of teacher-student and lawyer-defendant, are highly unevenly structured in terms of information and expertise.The “bene fit chain” between the two is thus severed. Unlike other commercial services, curing the sickness to save the patient, involving humanity and human rights, should be bound within government’s responsibilities and should not be entrusted to the market in this regard.What many western countries currently practice is just that, such as in Australia,where 4% of national revenue is allocated to cover everybody’s medicare.

[6] In the West, medicine is a respected and well-paid profession, which contrasts remarkably with the situation in China where doctors have been scolded and beaten, even murdered at will by their patients. No wonder some friendsof mine are stubbornly opposed to their children studying medicine; some medical school graduates have also diverted into other occupations. According to the “laws” of the market, the scarcity of medical resources should result in both status and financial appreciation of its providers; the current bizarre situation is completely abnormal, which can only be put down to the government’s rigid medical management of its amount,size, location and so on oriented by the planned economy, where it is hard for the “invisible hand” to play its role.

[7] Also, medical practitioners by nature are self-employed individuals,whose private practice has been proved in foreign countries to be an effective way to improve the doctor/patient ratio under the government’s strict regulation of doctors’ qualifications and medical practice. However, this kind of marketization still seems to be a painfully slow process in China now.

[8] Clearly, the crux of the current medical reform should not be generalized as lacking any market mechanism,but rather a more specific analysis would find that so-called marketization has taken place in the wrong areas. In a way, a more radical reform guided by integrated design is urgently needed, so as to achieve the result of “treating both symptoms and root causes”. ■

普遍认为，近年来的医疗改革是不成功的，体现在看病难、药价高、医患关系紧张等。究其原因，有专家认为是其改革的市场化1对此有许多译法，除marketization外，还有general adoption of the market principle、something marketable等，而标题更由于“辨析”而具体处理成“Medical Reform: How Is It Oriented to or by the Market?”。不够。但我却以为，并非如此简单2一般可译成“maybe not be sosimple”“…that it is not that simple”等，这里稍作变通。。

[2]在海外十余年后回国，有一突出感觉，就是媒体上泛滥3这里的flooded由自然现象转意，更口语化些，其他还可用inundate、widespread、awash等。如：①A visit to Japan may not be necessary to understand how inundated Japanese pop culture is with Western Culture.（无需到日本，便可知道西方的影响在那里的流行文化中有多么泛滥。）②He said he’d seen no evidence of widespread fraud.（他说并未见诈骗泛滥的证据。）③The city is awash with drugs.（该城市毒品泛滥。）的医药广告，与西方形成强烈反差。在那里，医生按病情开药，药行按医生处方供药，根本无需广告，而药价、药售与医生无关。国内的医生则不然，他们还要担负起“以药养医”4其意为“以医生的劳动来实现药品的高附加值，以药品的高利润拉动医院的经济效益，维持医院的正常运转”，直译为to cover hospital expenses with medicine revenue，一般可译成drug-maintaining-medicine，但provision用作动词时有“providing someone or something with …”之意，故用此词。的重任，以维持经营，提高收入。窃以为，这就大错特错了。

[3]医生的天职是看病、医治、救人，在这一点上，医生与病人的根本目的是一致的5有多种译法，如“fundamentally… all agree ...”“be basically consistent with”等，甚至可变通为“after all, …have the same dream and ultimate value”等，取决于具体语境。。医生的回报和成就感，应当仅仅从治疗病人的成效中获得，而一旦掺入其他因素，必然带来根本性质的变化。

[4]医学不是一般的自然科学，要与人打交道，故是一种特殊的社会文化。有专家指出，当前医患关系紧张6亦可译成tentional doctor-patient relationship，或变通为physician-patient relationship has been intensi fied等。的原因，在于医生与病人不成比例；……