兩票制 - two invoice policy

其實有關醫改的會議近兩年一直在翻。國內醫改進行的如火如荼，政策也是瞬息萬變，因此各大葯企和醫療設備企業也是一直在跟進，醫院走訪或者工作彙報、專家研討的時候都會碰到，行業會議感覺倒是偏重講技術。今天只能選取其中的一個－兩票制，也算管中窺豹吧。後續爭取慢慢補齊行業大背景。

因為大多數是中譯英，因此本文大多數翻譯都是proposed translation，而非官方譯法。

兩票制，只看字面意思，我們第一次給翻譯成two vote system...也是醉了

要查資料，查資料，查資料...勤動手，勤動手，勤動手，重說三，自勉。

先看新聞吧：

近日，備受關注的藥品採購「兩票制」政策落地。在日前舉行的2017年國家衛生計生委首場例行新聞發布會上，國務院醫改辦會同國家衛生計生委等8部門聯合出台的《關於在公立醫療機構藥品採購中推行「兩票制」的實施意見（試行）的通知》（以下簡稱《通知》）正式對外發布。《通知》明確，在公立醫療機構藥品採購中推行「兩票制」，即藥品從生產企業到流通企業開一次發票，流通企業到醫療機構開一次發票。據了解，「兩票制」將在全國11個綜合醫改試點省和200個公立醫院改革試點城市的公立醫療機構率先推行，2018年在全國全面推開。

（來源：網易新聞國家版「兩票制」出台 問診葯價虛高）

ECO經濟觀察網上列出了對於兩票制的比較籠統的解釋

（兩票制改革後，上萬家葯代將沒有明天 - 經濟觀察網 － 專業財經新聞網站）：

「所謂兩票制，即葯企出廠時開一次發票，藥品配送商（加上配送費用）出庫時再開一次發票，從而到達醫院銷售端。比如，一個藥品醫院中標價是30元，第一個環節中 廠家開票25元（包括了代理商招標等一切佣金費用），通常配送商再加5到8個點，最終中標價為30元配送到醫院。

兩票制以前的大概模式是，一個醫院中標價30元的藥品，藥廠的出廠價會開到10元左右，藥品代理商負責藥品的招標、醫院中標、藥物使用的說明培訓等等，當一切理順後，代理商以25元左右的價格流通到配送商業公司，配送商一般還會加5到8個點的運行費用，最後配送到醫院。」

Fiducia諮詢公司網站上的簡要介紹如下：

(Source: China』s Two Invoices System: What Medical Equipment Manufacturers Need To Know)

用大白話說，就是減少藥品和醫療設備採購的中間環節，減少產品加價（mark-up）

然而作為一個政策，對於「manufacturer」製造商和「distributor」經銷商的定義，就有了很多不同的界定和解釋。因為這是一個試點政策，不同的省份又有不同的定義，因此Pharm&Medical Device companies會去搞清楚自己屬於哪一種情況。

兩票制是醫改過程中很重要的一個舉措。因此很多外媒報道時都介紹了中國醫改的行業背景。

列一些醫改術語，僅供參考：

回扣 kickback

多點執業 multi-site practice

全面深化醫療改革 comprehensive and deepening health care reform

全民醫保 universal health care

集中採購 centralized procurement

總額預付 global budget

城鎮職工基本醫療保險 urban employee basic medical insurance (UEBMI)

城鎮居民基本醫療保險 urban residents basic medical insurance (URBMI)

新農村合作醫療體系 new rural cooperative medical system (NRCMS)

（總額預付和分級診療在下次的專欄中再細說吧，都是外延很廣的術語，能把知識理清楚是很有成就感的一件事呢）

還有一張中信資產的報告，回顧了2009年新醫改以來的政策進步。大家找找看能有多少術語？

大病醫保 critical illness insurance

醫保報銷 reimbursement

分級診療 tiered diagnosis and treatment

醫藥分開 separation of Rx and dispensing

現款支付費用 out of pocket expense

EDL 基本藥物目錄 essential drug list

RDL 醫保目錄 reimbursement drug list

另有一些術語，翻譯中只能令我等感慨中華文化之精深，以及政策制定者為制定口號（？）語言之凝練。。。比如：

科工貿一體－科技研發、工業生產、貿易銷售－company with R&D, manufacturing and trading capabilities

雙向轉診－小病進社區，大病進醫院－patients referral system/two-way referral system

諸如此類，苦瓜臉＋攤手：（

其實最想講的，不單純是術語，而是面對新名詞／中式辭彙的翻譯解決思路。

大學裡有一類作業叫做paraphrasing（複述），也就是用不同的表達方式，去代替原來的說法。當時甚是不解，但是工作了之後才了解這項基本功有多麼重要。短時間內，你能否用不同級別、register（語域）、風格的短語去描述同一個意思，尤其是中到英時，這是真正考驗譯員水平的能力之所在。想做翻譯的童鞋，平時不要過分糾結背單詞，但是一定要多注意輸入端平行語料的閱讀，去對照，去記錄，去擺脫中式思維。好比「醫療行業簡介」，翻譯的時候能不能從An introduction of Chinas medical care industry，變成Chinas Health Care Industry Overview...哦對了有本書叫做《中式英語之鑒》，經典而實用。

最後截一段the diplomat網站上的中國醫改新聞，標紅了一些可以注意的詞，供大家參考。

China』s Health Care Reforms

China』s National Health and Family Planning Commission衛計委 and State Council have been working to reform the health care sector, which faces excessive dependence on drug sales for income, low pay for doctors, insufficient support from local governments, and low interest in private hospitals. Some ways in which officials are tackling health care reform include addressing drug sales in hospitals, reducing price controls on drugs, promoting the growth of private hospitals, and improving the quality of health care staff.

The State Council laid out health care reform objectives in a May 9 Circular, including the objective to eliminate drug markups as well as plans to make medical services of public hospitals more affordable and improve the quality of the staff. Implementation of performance assessments in hospitals is to help ensure that medical staff who do a better job will be paid accordingly.

The elimination of drug markups is to address the problem of excessive dependence on pharmaceutical income faced by hospitals. China』s leadership has committed to eliminate the mark-up on drug sales in hospitals over the next two years. County-level pilot programs eliminating the markup have faced losses, as an important source of income has been cut, even in the face of increased government subsidies and reduced price controls to hospitals in the initial pilot program. Prefecture-level cities are next as test regions before the reform becomes widespread. Government spending on hospitals is encouraged; currently, government expenditure in the area accounts for 5 percent of GDP.

Price controls on drugs also present a problem for both patients and pharmaceutical companies. China is the third-largest consumer of pharmaceutical products in the world. Price restrictions have, in some cases, led to shortages in production of vital low-cost drugs. The rollout of guaranteed supplies of widely used drugs was carried out in 2014 to ensure the availability of low-cost drugs and pediatric drugs. In addition, price caps on 280 basic medicines manufactured by Western pharmaceutical companies and 250 medicines made by Chinese companies were lifted. China has also pledged to further lift price controls on medicines to promote innovative drugs.

Public hospitals face challenges in providing care to those who need it. To combat this, the number of private hospitals has been on the rise, especially since China lifted restrictions on foreign investment in private hospitals in 2012. Smaller and financially challenged public hospitals have also faced privatization. However, private hospitals still provide less than 10 percent of total health care services. Patients are less familiar with private hospitals, which often have fewer qualified physicians and weaker local government financial support. The State Council has sought to expand use of private health care services to 20 percent in 2015.

Public hospitals are also overwhelmed with demand because patients often tend to travel to larger hospitals even for mild health problems, neglecting local community-level medical institutions. The State Council has emphasized the necessity of increasing the quality of healthcare in local medical institutions. The National Health Family Planning Commission plans to address this issue soon to build up a multi-tier treatment system with two-way referrals.

Health insurance is also on the reform agenda. Although China currently has almost universal health insurance coverage, limitations abound, particularly for those with severe illnesses. Public health insurance is basic, while private health insurance is underused. To encourage use of private health insurance, the government has announced a pilot plan to give tax breaks to private health insurance policy holders. Policyholders will be able to deduct 2,400 RMB per year from assessable income for health insurance premiums.

China』s health care system is fraught with inefficiencies that the leadership is attempting to address. The active reform process undertaken by the State Council and the National Health and Family Planning Commission indicates that over time, these inefficiencies may be eliminated. Some reforms, however, will take longer than others, particularly improving the quality of health care and changing patient views regarding local and private hospitals. Yet these are essential components of building a modern society.

曾經有醫療行業的同事問如何提高醫學英語水平。感覺輸入多了應該自然而然就可以了，多聽多看，無他吧，也是需要時間和執行力的。

麥肯錫的醫療行業報告是不錯的資源，可以定期閱讀。他們在podcast上也有節目，定期更新行業研究報告和radio program，坐地鐵的時候可以聽一聽的。短期內不會有立竿見影的效果，但語言就看積累了。畢竟What comes easy wont last, what lasts wont come easy哦。

Healthcare & Pharmaceuticals - McKinsey Greater China

Podcasts - McKinsey Greater China

今天就到這裡，感謝你來：）