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            教授觀點 | 北大國發劉國恩:對全球疫情的反思

            北京大學國家發展研究院 2020-08-11 瀏覽量: 1865

            背景介紹:

            新冠肺炎疫情的蔓延給世界各國人民的生命安全和身體健康帶來嚴重威脅。病毒的肆虐需要中美兩國合作面對,共同克服眼前的困難。在此背景下,美國美中關系全國委員會和北京大學國家發展研究院邀請中國和美國的頂級專家開啟中美健康二軌對話特別公共活動,對公共健康改革、隔離政策與醫療衛生供給等方面的問題進行深入的探討。

            COVID-19 has brought unprecedented health threat to people around world. The rapid spread of COVID-19 calls for the cooperation between China and United States to tackle common threats. In this context, a virtual program with experts from China and U.S. was held by National Committee on United States-China Relations and the National School of Development at Peking University to discuss the topics of public health reforms, containment strategies, and healthcare delivery, and further reforms.

            【嘉賓觀點】

            中國采取了全國上下嚴格的管控措施應對新冠疫情

            首先,中國采取了全國上下嚴格的管控措施應對新冠疫情。在強大的中央政府指揮下,采取了封鎖、檢測、追蹤和隔離阻斷等一系列措施。更重要的是,各級地方政府緊跟這些措施,通過嚴密社區網絡管理,在供應側(企業)和需求側(家庭)同時發力干預,得以實現幾乎所有地方的全覆蓋。

            Under the command of our strong central government, a series of measures were implemented, such as lockdown, screening, tracing, and isolation. More importantly, these measures were closely followed by the local governments to implement, a nearly universal coverage of the state interventions through the highly regulated nationwide community networks on both supply side – for business, and demand side – for household.

            不同國家文化的差異

            其次,非政府因素對健康的結果也很重要。不同國家的人們在社交距離等自我行為防控上也有明顯的差異,背后的主因之一來自于不同國家文化間的差異,比如個人對健康和財富之間的權衡、生命的長短和生活的質量取舍上的選擇差異。國家間的文化差異帶來行為上的差異,從而也影響抗疫的健康結果。比如,為了抗擊疫情,中國和印度都推行了非常嚴格的政府管控,但是兩國人們的自身防控行為很不相同,這對兩國的不同健康結果有著重要的影響。另一個有趣的例子是中國和日本。中國的政府規定防控力度更加強大,日本則更多強調和依靠公民的自律行為,也在經濟和健康兩個方面取得突出成效。

            The non-governmental conditions also play a vital role in the health outcomes. For instance, people from different cultures may behave differently on social distancing and self-protections. Trade-offs between health and wealth, or quantity and quality of life may contribute to different outcomes. For instance, both China and India take very strict state orders, but people between the two nations behave quite differently in risk protections against the virus. Consequently, the two nations had quite different health outcomes. Another interesting example is China and Japan. China is much stronger in government order, while Japanese government counts more on the role of good citizens’ self-compliant behaviors, also resulting in outstanding economic and health outcome so far.

            公立醫院的運用

            第三,中國充分利用公立醫院的優勢來應對疫情。為了抗擊病毒,政府在全國范圍內動員了42000多名醫務人員加入到湖北武漢抗擊病毒的第一線,同時從全國衛生系統大量抽調醫療技術物資支援武漢等湖北省的感染城市。得益于這些保障條件,確診患者應收盡收,幾乎所有確診病例都在公立醫院得到治療。

            Public hospitals have been fully utilized to contain the pandemic in China. The government mobilizes more than 42000 healthcare professionals from nationwide to join the front-line Wuhan, Hubei to fight against the virus. A broad range of medical and technological supplies, most of which are from the public health system, are provided to support Wuhan and other areas in Hubei. As the result, almost all confirmed cases receive treatments in public hospitals.

            關于中國疫情防控過程中的思考

            首先,疫情防控的成本有效性。固然,所有COVID-19患者在大醫院能夠得到優質的治療服務。一個有待探究的問題是,將所有患者集中醫院救治是否具有經濟學的成本有效?根據國內外的大量流病研究結論,新冠患者80%以上屬于輕癥,其中大多可在基層醫療機構和社區衛生服務中心得以很好的照料康復。假如新冠疫情以后每年成為人類的“??汀?,并且發生規模涉及多個地區,那么在醫院收治所有患者的醫療模式不僅可能存在可持續性問題,同時還會閑置大量基層醫療機構的人財物資源。

            第二,在全國大幅傾斜配置醫療和財政資源集中應對COVID-19患者的同時,許多其他疾病的患者由于大多醫院強行要求關閉或減少相關科室而不能獲得及時治療。從醫療資源配置效率和社會福利的綜合考慮,我們應該在COVID-19造成的可見生命損失和其他主要死亡殺手的無形生命損失之間進行更科學、更理性的決策權衡。作為參考,根據2020年全球疾病負擔上半年的數據可知,迄今為止,全球COVID-19的死亡人數平均每天約為3500人,而人類面臨病死風險的“頭號殺手”心血管疾病的日均致死率高達48000多人。

            First, while almost all COVID-19 patients in Wuhan obtained good-quality treatments from hospitals, but a question remained is whether and how it is economically cost-effective to treat all patients in hospitals regardless of their conditions? Epidemiological data finds that over 80% of the confirmed cases are in mild conditions, many of which may be better treated in community-based healthcare providers or even home care with an appropriate medical support. What if COVID-19 would be back for multiple times and would be at a much larger scale in many regions in the future? Would it be sustainable to treat all patients in hospitals while idling many of the non-hospital facilities and resources?

            Second, allocating almost all medical and financial resource nationwide to focus on treating the identified COVID-19 patients, many patients with other diseases such as cardiovascular or cancer conditions were put on hold without immediate treatment due to hospital shutdown or limited access to care. It is necessary to consider the trade-offs between visible lost lives immediately from COVID-19 and invisible lost lives from other leading killers. As a reference, the total death tolls of COVID-19 around the world were about 3500 per day for the first half year of 2020, while cardiovascular disease alone killed over 48000 people per day globally.

            討論Discussions:

            中美如何合作?“How China and US can collaborate?”

            美國是技術領先者,中國是追趕者,美國更為關注技術竊取和知識產權保護等問題,這在情理之中,也可以理解。但為了更好促進兩國之間良好而有效的合作,美國如果能夠制定出更為透明和易于遵循、執行的指南,這對兩國和整個世界都會更有益處。兩國研究人員因此可以通過訪問計劃、教育計劃和其他舉措繼續進行交流學習。

            US has been a technological leader, and China is still a follower in many fields. It is reasonable and understandable for US to concern more on technology stealing and intellectual property right protections. In order to promote a good and effective collaboration between US and China, I think it is good for US to come up with more transparent and easy-to-follow guidelines. Following such guidelines, researchers in both countries can continue to perform exchanges in science and technology through visiting scholar programs, educational programs and other initiatives.

            關于指導方針“About the Guideline”

            我非常關注當前不利于中美兩國以及全球合作的政治環境。但無論喜歡與否,我們的社會都由政府管理。因此,我再次呼吁兩國政府見面、對話和商談,能夠形成更為透明、易于遵循和實施的行動指南。這樣,我們就能向前邁進,更好推進全球合作。

            I am very much concerned with the current political environments that are not instrumental to our collaborations globally. Whether like or not, we are all run by governments. I highly recommend that the two governments meet, talk, and discuss to come up with collaborative guidelines that are transparent and easy to follow and implement. With such good guidelines available, we can move ahead to better collaborate around the world.

            (何慶紅、姜又菲整理)

            劉國恩,北大博雅特聘教授、教育部長江學者特聘教授、北大國發院教授,北大中國衛生經濟研究中心主任。劉國恩教授研究領域為健康與發展經濟學,國家醫療體制改革,以及醫藥經濟學。

            編輯:顏回

            (本文轉載自北京大學國家發展研究院 ,如有侵權請電話聯系13810995524)

            * 文章為作者獨立觀點,不代表MBAChina立場。采編部郵箱:news@mbachina.com,歡迎交流與合作。

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