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伯格海角陆乌龟怎么样好养吗飞度常识

2019年10月16日 21:29:24 | 作者:健康面诊 | 来源:新华社
Books and Arts; Book Review;Diana Athills letters;Dear Edward;文艺;书评;戴安娜·阿西尔的信;致亲爱的爱德华;Instead of a Book: Letters to a Friend. By Diana Athill.并不是一本书,只是些给朋友的信。戴安娜·阿西尔著。Diana Athill was well past normal retirement age when she wrote a series of memoirs that made her a cult figure. As a young woman she had written a novel, a collection of short stories and a cathartic memoir about being jilted by her lover. But her literary skills went mainly into editing the books of others at André Deutsch, a London publisher, where she worked for decades until she was 75. Near the end of this career she started writing again, and over the next 22 years she produced five more memoirs, including “Stet”, an acclaimed account of her editing life, working with authors such as Philip Roth and John Updike, published when she was 83. She finished with “Somewhere Towards the End”, about getting old, for which she earned the Costa Biography prize as well as an OBE in .当戴安娜·阿西尔完成自己的系列回忆录,备受追捧的时候,她早已经过了正常退休年龄。年轻的时候,她也写过一部小说,一本短篇故事集,还有一本宣泄感情的回忆录,记述的是她被爱人抛弃的故事。但是她在伦敦André Deutsch出版社工作期间,其文学上的天赋主要投入了编辑出版别人的书,而这一做就是几十年,直到她七十五岁才退休。在她职业生涯结束之际,她重新执笔开始创作,在接下来的22年间先后又出版了五部回忆录。其中包括她83岁那年出版的回忆录《留存》。这本书记录了她当年和像菲利普.罗斯、约翰·厄普代克这样的作家一起共事的记忆,称颂了自己的编辑生活。此后,她凭借《终点前某处》(有关老年生活)的创作,于年获得科斯塔文学奖同时被授予大英帝国勋章。Now 93, Miss Athill still takes speaking engagements, but her writing seems to be behind her. So it is good to have this new collection of her letters to Edward Field, a close friend, spanning a period of 26 years. This is not just squeezing the lemon for a bit more juice. By their nature these letters are quite different from the polished prose of the memoirs. They are spontaneous and unstructured, full of daily minutiae (visits to the dentist, car trouble, useless builders) and delightful snippets from her colourful personal life. She gossips about mutual friends and tells stories about the literary world she is immersed in (“I am going to have an interesting lunch tomorrow with the mistress dumped by Vida Naipaul when he married his Indian wife”). Mr Field, a poet six years her junior, is gay, so he was never one of her many lovers, but the relationship is clearly very close, both personally and professionally.现龄93岁的阿西尔女士仍然会去做演讲,不过她在写作方面似乎没有跟上。所以说这本新鲜出炉的书信集是一次很好的尝试。其收信人是阿西尔女士一位的密友爱德华·菲尔德,信件的时间跨度则有26年之长。这可不只是为了多榨点汁而去挤柠檬。从其本质来说,这些书信与回忆录里那些优美的散文可谓是大相径庭。这都是发自肺腑之言,随性而为的叙述,满是日常生活的细枝末节(像看牙医,交通纠纷,失效的洗选强化剂),还有她丰富多的私生活里那些幸福的片段。她闲话自己的好朋友,也会说些关于那个她所沉浸其中的文学世界的故事(“我明天要和被韦达·奈保尔抛弃的那个女人一起吃午饭,这一定很有趣,要知道韦达要娶个印度女人”)。菲尔德比阿西尔小六岁,是一位诗人,不过是同性恋,因此他也绝不会成为阿西尔的众多情人之一,但是很显然他们之间的关系不论是私交还是在专业领域都非常亲密。For all Miss Athills pleas of relative poverty, hers has been a privileged life. Raised in a grand country house, she lived for decades in Primrose Hill, a salubrious bit of London, in a house belonging to a cousin (a journalist at The Economist, it so happens), with weekends in the cousins Norfolk cottage and lots of trips to places like Venice and the Caribbean. When money seemed tight, cash always turned up from somewhere. Her voice on the page is that of an upper-middle-class Englishwoman—good things are “dear” or “darling”, bad things are “tiresome”, “horrid” or “vile”. But she also swears like a trooper and does not care what people think.尽管阿西尔一直声辩自己比较穷困,她的生活其实非常优越。在豪华的郊区住宅长大的她,之后在伦敦环境宜人的樱草花山也住了有几十年。房子是她一个表兄的(经济学人的记者,很巧),周末则到她表兄的诺福克别墅去小住,没事就去像、加勒比海这样的地方旅行。手头紧的时候,钞票总是又会在哪冒出来。字里行间透露的是那种中上层阶级英国女性的调调:好的事情则叫“宝贝”呀,“亲爱的”呀,糟糕的事情则说“讨人嫌”呀,“讨厌”呀,或者是“糟透了”。但是她也会像巡警一样破口大骂,完全不在乎别人怎么想。Miss Athill did not keep the letters she received from Mr Field. When he suggested that hers be made into a book, she had reservations about “publishing ones private conversation”, particularly if it meant printing only “half the conversation”. Luckily he persuaded her, and the result makes for addictive eavesdropping. Miss Athill writes beautifully, even about mundane subjects, and it is fascinating to follow the change in her preoccupations with advancing years. The letters are frank about the indignities of getting old, from hearing aids to cataract operations, and about the burdens of looking after Barry, her increasingly ailing Jamaican partner.阿西尔女士并没有保留菲尔德给她写的信。最初还是菲尔德建议她把自己那部分的信件整理出来出本书,但阿西尔对于“公开私人谈话”的做法还是有所保留,尤其如果是要仅仅发表“一半的谈话内容”。幸亏菲尔德说了她,结果这本书出来让人们迷上了“窃听”。阿西尔的文字非常漂亮,即使是写微不足道的小事也毫不逊色。读者会情不自禁地跟随她,关注她一直所关心的事情随着年华逝去将会如何变化。阿西尔在信中坦率地表达了老年生活的窘困,从助听器到白内障手术,还有照顾她那位病情日甚一日的牙买加伴侣——巴里。But Miss Athill is too clear-eyed to become a bore about such things. Her correspondence with Mr Field continues, now by e-mail, but the letters in the book end in 2007. She explains in a postscript that this is “because we have become old and…too often the experience old people have to share is wobbly health.” Enough said.但是阿西尔的头脑可是相当精明,她才不会对这种事情一钻到底。她与菲尔德的通信一直在继续,只是现在改成发电子邮件,但是书中的信件则截止到2007年。她在附言中解释到,这是因为“我们都年事已高,而且……老年人之间能够分享的无非就是不稳定的健康问题”。说得应该够多了吧。 /201305/241771Business商业报道Sexual harassment性骚扰Nasty, but rarer龌龊,但是更少了Still a live issue in the workplace仍然是职场的热门话题THREE women complained of unwanted advances from their boss at the National Restaurant Association.在全国餐饮协会,三位女性投诉了来自她们老板的过分殷勤。Two received financial settlements.其中两位已经收到了经济补助。Because the boss in question was Herman Cain, now a Republican presidential hopeful, this news has revived a long-running debate about sexual harassment in the workplace.因为怀疑老板可能是现在的共和党总统候选人,赫尔曼.凯恩,这次的新闻重新上演了关于工作场所性骚扰的长期争论。The details of the complaints made in the settlements have remained private.在解决协议中关于投诉的细节已经被保密了。A fourth woman who has alleged that Mr Cain groped her was not an employee at the time and did not receive any settlement.第四位女性声称凯恩在非工作期间也曾猥亵她,但她并没有收到任何解决协议,Mr Cain denies that he did anything inappropriate.而凯恩否认自己做过任何不恰当的行为。The fact that there has been a settlement does not by itself tell you there was any truth to the allegations,事实是就算有解决协议,也并不意味着那些指控就都是真实的。says Richard Simmons, an employment lawyer at Sheppard, Mullin, Richter amp; Hampton.一位来自谢帕德的里和汉普顿公司的律师Richard Simmons这样说道。Firms often pay off disgruntled accusers rather than go to court, since juries are unpredictable, damages can be steep and the publicity of a trial is always unwelcome.公司经常付清不满的起诉者的工资,而不愿意去法庭,因为判决是无法预测的,损害可能会更大而且公开的审判总是不被希望的。Conservatives think the deck is stacked against employers. Liberals disagree.保守派们认为各方面都对雇主们都是不利的,但是自由党们并不同意。Mr Simmons thinks sexual harassment is much less widesp in the American workplace than it was in the 1990s.Simmons先生认为和20世纪90年代比,性骚扰在美国工作场所的发生频率已经减少了很多。The number of harassment cases tracked by the Equal Employment Opportunity Commission has risen, but this is probably because victims are more likely to report it.而由平等就业机会委员记录的骚扰案例仍然在上升,但这主要可能是因为有更多受害者愿意举报。A Supreme Court ruling in 1986 made firms liable if they allow a hostile environment in which harassment is tolerated.一个在1986年统治的最高法院认为,如果公司可以容忍性骚扰的存在,那么它们要对这样一个时刻要小心的环境负责任。This led to the near-universal adoption of codes of conduct, setting out how coworkers may interact and limiting how bosses may behave towards underlings.这导致了采用普遍的行为法则,制定出了同事间该如何互动和有哪些被限制的行为以及老板要如何对待下属的规定。Industries such as carmaking and finance, which once produced big sexual-harassment lawsuits, are less male-dominated than before,像曾经提出了大的性骚扰案件的汽车制造业和金融业,和过去相比,已经不再是那么地以男性为主导了。which may explain why they appear to have cleaned up their acts.而这,也可能解释了为什么他们看起来已经不再有这些行为了。The worst behaviour today tends to be in industries where women are a small minority,在今天,最恶劣的行为更可能在女性只占小部分的行业,such as construction or firefighting, or where workers are disproportionately young or too desperate to complain, says Michelle Caiola of Legal Momentum,如建筑业和消防工作,或者在年轻人尤其多的快餐店和因太恐惧而不敢投诉的人身上发生,来自 Legal Momentum的Michelle Caiola这样说道,which provides legal support for women.而这个机构是为女性们提供帮助的。Lawsuits about gross misconduct have given way to lawsuits alleging discrimination on pay and promotion.关于恶劣的不法行为的诉讼案件已经少于像在工资和职位晋升中受到歧视这样的案件了,Such cases typically hinge on different interpretations of statistics rather than differing accounts of what happened by the photocopier.因为它们通常取决于不同数据的解释,而不是影印机记录下的不同描述。Victims often are reluctant to complain, for fear of retaliation.受害者们通常会因为担心遭到报复而不愿意举报。In the past year, however, the Supreme Court has favoured victims in four cases alleging retaliation after various types of complaint—a rare instance of the current court ruling against business.但是在过去的这些年里,最高法院已经特别照顾了在四起不同控诉中担心遭到报复的受害者们了。而这,在反对商业的现代法庭中并不常见。American business is far from perfect, but it is generally agreed to be leading the way in tackling sexual harassment.美国的商业还远不够完美,但是在处理性骚扰问题上已经有大体上一致的意见了。Most other countries have a lot of catching up to do.很多其它国家也赶了上来,It is only three years since a judge in St Petersburg, Russia, threw out a case on the ground that:只是在三年前俄罗斯的圣彼得堡的法庭上,一位法官在处理案件的依据竟然是:If we had no sexual harassment we would have no children.要是我们没有性骚扰,那么我们也就没有孩子了。 /201304/235807Americas hospital industry美国医疗行业Taking a scalpel to costs对医疗费用动动刀Hospital operators brace themselves for health-care reform医院负责人正为医保制度改革做准备EARLIER this month Americas hospital bosses gathered in Washington, DC, with vice-president Joseph Biden.本月早些时候,美国医院的领导者们和副总统Joseph Biden齐聚华盛顿。To the amazement of many, they vowed to accept a cut of 5 billion in their expected revenues over the next decade as part of a grand bargain on health-care reform.令人感到惊奇的是,他们郑重同意在接下来的十年将预期收益削减1550亿美元,作为医疗保健改革已取得的巨大成效中的一部分。How can they justify giving away such a vast sum?他们为什么会同意放弃这么大一笔收益?There are several explanations, not all of them altruistic.对此有很多种解释,他们的动机也不全出于利他。Taken together, they show that the industrys leaders are bracing themselves for a period of upheaval.总之,他们已经显示出整个行业的领导人正积极应对未来行业的大变动。For hospitals, the positive thing about health-care reform is that it is going to be good for business.对医院来说,医保改革带来的好处是它对商业有利。It will be welcome news to an industry that is hardly in rude health.改革对于一个不太健康的行业来说总是好事。Despite two decades of consolidation, hospitals finances remain anaemic; over a quarter of them regularly post negative operating margins.诚然,医保行业走过了二十年的稳固期,但是医院的财经状况仍旧不景气,超过四分之一的医院存在周期性亏损。The recession is making things worse.而且现在的经济危机更是加剧了形势恶化。Moodys, a credit-rating agency, notes that many patients are putting off non-essential treatments.信贷评级机构Moodys注意到很多患者正在推迟一些非必须的治疗。So any reforms that promise a flood of new demand for health services should be welcome.因此任何可以使得医疗务的需求大幅增长的改革承诺都应该是大受欢迎的。Rich Umbdenstock, the head of the American Hospital Association and one of the bosses who shared the stage with Mr Biden,作为美国医院协会会长的Rich Umbdenstock和与副总统Biden先生见面会谈的领导人之一,acknowledges that extending health insurance to most of Americas nearly 50m uninsured will benefit his industry in the long term.承认从长远看来,为没有享受医保的五千万美国人提供保险将会使整个行业受益。Those unfortunates still turn up at emergency rooms and often do not pay their bills.这些没有医保的人们经常出现在急诊室里而且无力付医药单。The government gives hospitals some money to compensate them for this, but the AHA says it does not cover the full cost,对此,政府会给医院发放一定数额的资金以作弥补,但是美国医院协会表示,这些金额不足以付资金缺口。which it put at billion in 2007, up from .9 billion in 1980.这些缺口已经从1980年的39亿上升到2007年的340亿,Paul Mango of McKinsey, a consultancy, estimates that the hospitals recover only 10-12% of this cost.大约占医院每年财政收入的5%。来自咨询公司麦肯锡公司的Paul Mango估计,医院大概只能收回这些资金的10-12%,But he says the problem would be greatly reduced under a system of universal health-insurance which included subsidies for the indigent, as the proposed health reforms envisage.但他也说,如果可以建立一个大部分人都享受医保并且贫困人口得到补助的体制,这些资金缺口就可以被大大减少,而这种体制正是当前的医疗改革尝试建立的。Herbert Pardes, chief executive of New York-Presbyterian, a research hospital, says the large numbers of underinsured patients, who frequently fail to pay their bills in full, cost hospitals still more.Herbert Parades是纽约一家研究型医院Presbyterian的总裁,他说,很多保额不足的病人不能全额付他们的医疗花费,这仍旧给医院带来越来越大的负担。The huge sums the hospitals stand to gain from reducing such losses make even 5 billion over ten years look like a reasonable amount of money to sacrifice to secure such a bonanza.如果医院在未来十年可以通过削减这种损失而获得1550亿的利润,那么这样的暂时性损失也是合理的。But there are less virtuous reasons why the hospitals offered such a generous-sounding deal.但是人们不知道医院愿意放弃这样一笔利润的背后仍有很多不太高尚的原因。As Mr Umbdenstock notes, it was less painful than the 5 billion or more in cuts that Barack Obama had been pressing for earlier in the year.正如Umbdenstock先生所说,相比奥巴马总统今年早些时候敦促的2250亿甚至更多的财政削减计划,现行的削方案就没有那么痛苦了。This is a tacit acknowledgment that hospital chiefs were seeking to avert the one thing that strikes fear into their hearts: the sp of price controls.医院负责人们早已心照不宣地承认,他们通过这样的变通,正在努力避免物价被控制,这正是会令他们惊恐不安的事情。Because of the creeping expansion of Medicare and Medicaid, the publicly funded health-care schemes for the elderly and the poor,在美国,为老年病人和残疾病人的国家医疗照顾体制正在慢慢向更多的公民扩展,the government aly pays over half the bills at the average American hospital.正因为如此,平均下来政府已经为每家医院付了超过半数的医疗费。But the political left is clamouring for a government-run insurance plan, to compete with private ones, as part of any reform effort.但是政治左派却在改革之中叫嚣一个政府操作的保险计划,以此来和私人运营计划相抗衡。The problem, argues Toby Cosgrove, chief executive of the Cleveland Clinic, a hospital group, is that the existing public schemes routinely underpay hospitals for care.Toby Gosgrove是,一个名为Cleveland Clinic的理疗团体总裁,他说,这样做的问题在于,现行的医保体制总是使得医院获得不足额的补助。Some economists question that claim.一些经济学家对此持怀疑态度。Even so, it is probably right to suggest,尽管如此,正如Cosgrove医生所建议的,as Dr Cosgrove does, that any public insurance plan based on Medicares pricing would squeeze hospitals hard and, as a result, require private insurers to cross-subsidise the bill.依照目前国家医疗照顾体制的集款方式所运营的任何公共保险计划都会使医院出现资金困难,结果仍旧需要投保个人来买单。In addition to a determination to head off any moves towards greater government control over prices,采取此项改革的一个重要原因是医院领导人们下定决心阻止政府对医药价格的进一步控制,another even less noble reason for offering the price cut was a desire to thwart a proposed change to the tax status of non-profit hospitals, which make up most of the national total of 5,700 or so.相比而言另一个不怎么高尚的原因则是领导者们试图通过减少削减开来抵制改变非营利性医院税收政策的提案,非营利性医院在全美有5700家之多。On the ground that they provide charitable care, many religious and community hospitals have been granted an exemption allowing them to issue tax-free bonds,由于很多宗教和社区医院提供慈善性的救助,他们都享有税收优惠的政策,可以发放免税券,免收财产和收入税收等等。avoid taxes on property and income, and so on. But investigations by the Internal Revenue Service and others have revealed that many in fact provide very little charitable care, while paying enormous salaries or going on acquisition sprees.但是美国国内收入署和其他一些机关的调查表明,有些医院提供很少的慈善性救助,他们所做的无非是领取高额工资,无节制地享受收益。On this proposal, the industry may carry the day.在这样的提案下,整个行业的反对可能会占上风。Although the tax break is hard to defend, closing the loophole would lead to many small, weak hospitals shutting down—something voters would be unlikely to tolerate.尽管人们很难为税务减免而辩护,结束这样的漏洞可能会导致很多小型医院的倒闭,这正是选民们不能容忍的事情。Even those hospitals that survived might spark a backlash.甚至那些得以幸存的医院也会引发人们强烈的反对。Dr Pardes argues that abolishing the tax advantages would mean higher running costs that would inevitably be passed through to those patients who have private insurance.Parades医生说废除税收优惠政策即意味着更高的运作成本,这无疑将给那些拥有个人医疗保险的病人施加经济负担。The other great fear of hospital bosses is being forced to accept greater competition.医院负责人们的另一个隐忧是被迫进入激烈的行业竞争。Although the industry is fragmented, Jon Scholl of the Boston Consulting Group points out that because pricing is done at city or regional level, there are local pockets of power.波士顿咨询集团的Jon Scholl指出,现在的医疗行业处于离破碎的状态,由于定价的过程是在某一城市或地区范围之内完成的,本地权利口袋影响定价的行为是存在的。Alain Enthoven, an economist at Stanford Universitys business school who helped inspire the managed health care movement of the 1990s, promoted an approach that succeeded in squeezing costs at the time,Alain Enthoven是来自斯坦福大学商学院的经济学家,他曾经在二十世纪90年代推动管理医保运动的开展。but ultimately failed as patients rebelled against the restrictions it placed on their choice of doctors and treatments.当时他推行的改革方案在削减成本方面颇有成效,但因为病患不满他们失去了选择医生和疗法的自由而抗议,这项改革以失败告终。Mr Enthoven argues that the consolidation that followed managed care has resulted in too little competition.Enthoven先生认为,改革失败后的相对稳固导致了今日几无竞争存在的行业格局。Antitrust action in the hospital field has been woefully weak, he says.他说:反垄断在医疗行业只是一句可悲的空话。There are some innovative competitors emerging to challenge hospitals.当然还是有一些富有创新精神愿意挑战垄断的竞争者出现。Paul Keckley of Deloitte, a consultancy, estimates that there are over 1,000 retail health clinics operating today at Wal-Mart stores,Deloitte咨询公司的Paul Keckley估计,在沃尔玛店铺,Walgreen药店还有其他的一些便利商店,总共有超过1000家药品零售诊所存在。Walgreens pharmacies and other convenient locations, and their numbers are expected to multiply in the next few years.在今后几年,这些零售诊所的数量有可能翻倍。Some of these cheap and cheerful outfits are staffed by nurse practitioners, which incenses doctors and hospital bosses.一些有医师资格的护士在这里工作,他们的工资水平比医师低很多,这让医生和医院负责人们很是恼怒。The nascent boom in medical tourism could also disrupt the hospital business,但医疗旅游近期的初步兴起还是困扰医疗行业的一个原因。even if every hip-replacement patient does not actually go to India to get it done.尽管不是每一个需要做髋关节置换手术的病人都选择去印度治疗,Mr Keckley points out that in several parts of the country the mere introduction of insurance plans offering cheap surgery abroad has forced local hospitals to respond by slashing their prices—something unheard of in this industry.Keckley先生指出,在美国的一些地方,出现了一些提供便宜海外手术的医疗保险计划,这就使得当地医院不得不采取减价策略,但事实上,减价在医疗行业是前所未闻的事情。Mr Enthoven argues that if reforms are done properly, they would force hospitals to get organised to compete and get more efficient.Enthoven先生说,如果改革可以成功实施,那么这将促使医院组织性更强的去参与行业竞争,而且将使整个行业提高效率。Alas, the omens are not good.但是,目前的预兆不太好。One of the explicit concessions wrung by the hospital bosses from the White House was a promise to crack down on clinics owned by doctors.医院负责人们与政府方面协商出的一个明确让步就是打击私人医生开设的诊所。These outfits are guilty of anti-competitive self-dealing, since the doctor has a financial motive to refer cases to his own firm,因为医生们出于经济动机可能会向自己的私人诊所推荐病例,这些小诊所违反了反竞争的自利交易原则,but what hospital bosses were really concerned about was that such clinics are competing hard with them, and siphoning off the most profitable patients.但事实上医院负责人们真正担心的问题是这些小诊所正与大医院激烈的竞争,大医院可能因此失掉那些可以让他们赚大钱的病例。As this back-room deal illustrates, the strongest motives behind the hospitals ostensibly generous price cut were self-serving ones: to reduce competition, not boost it,正如这个密室协议所明的,在医院表面慷慨削减开的背后,最真实的动机却是自我获利:and to head off any increase in government influence over their prices.非但不促进,反而减少竞争,并竭力避免任何可能出现的政府对价格的管制。As health-care reform forges ahead, reformers are desperate to find cost savings and the hospital industry is a juicy target.医保改革就在眼前,改革者们将会失望的发现医疗行业减少开的目标很难实现。So its bosses felt they had to cut a deal.所以行业负责人们觉得他们必须做笔交易。As Julius Hobson of Bryan Cave, a veteran health lobbyist, puts it: If youre not at the table, then youre on the .Julius Hobson,是Bryan Cave公司的一个老兵健康游说者,现在的情形正如他所说:如果你不愿意主动出击,那你就等着被人利用吧。 /201304/237221Private hospitals in Asia亚洲私立医院On call随时候命Hospital companies prepare to meet surging demand for health care in Asia亚洲私立医院正准备迎接医疗需求的激增A HUMID breeze wafts through the wards of Siloam General Hospital in Tangerang, near Jakarta. There is no air-conditioning, one of many ways the hospital contains its costs. Each room has dozens of beds arranged in neat aisles, privacy ostensibly offered by beige curtains. The open plan means that fewer nurses can tend to more patients. Families wait in long hallways, open to the car park.位于雅加达附近文登镇的西罗亚综合医院里,一阵潮湿的微风拂过墙壁。出于医院经营成本的考虑,这里并没有空调设备。在每个房间里都有许多病床被安排在了整洁的过道当中,个人隐私表面上则由一张张米黄色帘子来保护。开放式的设计意味着少量的护士能够负责更多的患者。患者家属们在长长的走廊上等待,队列一直延伸至停车场。The adjoining Lippo Village hospital feels rather different. Families lounge in the lobby, sipping lattes bought at the hospitals Starbucks. Pastries are sold in another shop, trinkets in yet another. Health care is for sale, too. The wealthiest patients are treated in the presidential suite, which has not just a bed but also a sofa, a refrigerator and a flat-screen television.毗邻的力宝村医院的环境则相当不一样。患者家属可以在休息室里等待,享受着医院内星巴克的拿铁。这儿有卖糕点的店铺,还有卖饰品的。同时,医疗保险也可以在这购买。最富有的病人被安排在了总统套房里,而该套房内不仅仅有一张床,还有一张沙发、一个冰箱以及一个超薄液晶平板电视。Both are owned by Siloam Hospitals, an Indonesian firm. The difference is that in the General Hospital, the government pays Siloam a capped price per patient for a given condition; in Lippo Village most patients pay for themselves.两家医院的拥有者都是西罗亚医疗,一家印度尼西亚公司。两家医院的区别是,在综合病院当中政府会为每一个患者在特定条件下付特定的补贴,而在力宝村医院当中,大部分病人是自己负担治疗费用。Siloam is part of a booming private business for hospital care in Asia. A bidding battle is under way for Healthscope, an Australian hospital firm which runs pathology services in Malaysia, Singapore and Vietnam. HCA of America, the worlds biggest hospital firm, is reportedly prepared to pay billion to outdo Fosun, a giant Chinese conglomerate. Last month a consortium agreed to pay 1m for Chindex, which owns a chain of hospitals in China. The group comprises Fosun, TPG Capital and Chindexs chief executive, who is married to a journalist on this newspaper.西罗亚公司是冉冉上升发展的亚洲私人医疗市场的参与者之一。围绕着澳大利亚医疗企业Healthscope的竞价争夺战正在进行当中,而这是一家业务范围涵盖马来西亚、新加坡以及越南的公司。据称,世界最大的医疗企业美国HCA正筹备50亿美元以在该场收购战中胜过复星企业,后者是中国医疗业巨头之一。上个月,某财团已经同意付4亿6100万美元来收购在中国拥有连锁医院的美中互利集团。该集团旗下拥有复星企业和德州太平洋,其CEO还与本报的一名记者结了婚。The companies have every reason to smell an opportunity. Although Asias emerging economies are slowing, the rise of their middle classes is continuing. In Indonesia the number of middle- and upper-income consumers is expected to swell from 74m in 2013 to 141m by 2020, predicts the Boston Consulting Group. Rising incomes mean rising demand for health care. The average Chinese city-dwellers health spending more than doubled between 2002 and 2010, estimates PwC, a firm of consultants.这些企业都有充分的理由去相信眼前的大好机会。虽然亚洲市场的经济增长趋缓,但中产阶级的人口比例在持续上升。波士顿咨询公司的预测显示,印尼中产及中产以上收入的消费者将从2013年的7400万人上升至2020年的1亿4100万人。持续上升的收入意味着持续上升的医疗护理务需求。据咨询公司普华永道估计,中国城市居民平均医疗出在2002年至2010年间增长超过了一倍。Governments are trying to meet this demand. Malaysia and Thailand aly have broad public health-care systems. China, which boasts that it has extended basic medical coverage to 97% of its people, continues to make reforms. The Philippines is in the midst of a rapid expansion of insurance. Indonesia is in the first year of a plan to bring health coverage to the entire population by 2019.政府正努力满足国家医疗需求。马来西亚和泰国已经拥有了广泛的公共医疗系统。中国声称自己的基础医疗覆盖范围达到了97%,其政府也在持续地进行医疗改革。菲律宾的医疗保险正处于快速扩张期。而对印尼来说,目前正是医疗改革的第一年,预备在2019年前完成对整个国家人口的医疗覆盖。However, in many countries hospital beds are in short supply. Indonesia has only nine for every 10,000 people and the Philippines ten. America and Britain each have 29. And the quality of public hospitals varies greatly. Governments throughout the region say they will open more hospitals. But private operators think there will be a continuing shortfall for them to fill.然而,许多国家的医院均出现了床位短缺的现象。在印尼,每10000人当中只有9个床位的供应量,而在菲律宾则是10个床位。美国和英国的指标则是29个床位。与此同时,公共医院的务质量参差不齐。整个亚洲地区的政府都对外强调他们会开设更多的医院。但私人医疗机构则认为将来会有持续增长的市场空缺等待他们去填补。Some companies, such as Chindex and Siloam, are concentrating on only one country. In China Phoenix Healthcare Group, which made its stockmarket debut in November, tripled the number of hospital beds it manages between 2010 and June last year. Deutsche Bank expects that Phoenixs revenue will grow by 20% a year between now and 2016. Siloam, which also went public in 2013, has 16 hospitals in Indonesia. By 2017 it intends to have 40.部分公司只把业务集中在一个国家,如美中互利和西罗亚。去年11月上市的凤凰医疗集团,在2010年至2013年6月之间将医院床位的供应量增至三倍。德意志预测该集团的营业额从今年到2016年会实现20%的年均增长。同样在2013年上市,且在印尼拥有16家医院的西罗亚集团,预计到2017年将旗下医院数提升到40家。Others, such as Healthscope and IHH Healthcare, a Malaysian company, have international strategies. In 2010 IHH, then owned by Malaysias sovereign-wealth fund, bought Parkway, a Singaporean chain of high-end hospitals. In 2012 it snapped up 60% of Acibadem, a Turkish hospital firm. It went public the same year. IHH is now the largest hospital company in Asia and the second-largest in the world by market value. Its business stretches from Abu Dhabi to Vietnam. At Parkways newest hospital in Singapore, the muted wall colours evoke a hotel; a special scent is piped in to mask antiseptic odours. “Universal coverage is no-frills coverage,” explains Tan See Leng, IHHs chief executive. “We offer the frills.”另外一部分公司则拥有全球发展战略,如Healthscope和马来西亚的综合保健控股(IHH Healthcare)。在2010年,由马来西亚主权财富基金所拥有IHH收购了新加坡高端连锁医院Parkway,在2012年则买下了土耳其医疗集团Acibadem高达60%的股权。2012年同年IHH正式上市。以市场价值来计算,IHH目前是亚洲最大、世界第二大的医疗集团,其业务范围从阿布达比市延伸至越南。Parkway公司在新加坡最新建立的医院里,柔和的墙面色让人感受到了酒店的氛围;特殊的香味持续地输入室内以缓和消毒药剂的气味。IHH首席执行官Tan See Leng解释道:“全民覆盖的医疗务只是没有任何附加的基础务,而我们会提供更多。”However, at least three obstacles lie in the path of Asias ambitious private hospital companies. The first is simply that doctors and nurses are scarce. Companies in China have trouble attracting doctors from public hospitals, which offer good pay and pensions. Indonesias rules for foreign doctors all but prohibit hospitals from recruiting them.然而,目前至少有三大问题阻碍着雄心勃勃的亚洲医疗企业。首先,简单地说就是医生和护士的短缺。由于薪水和养老金方面的原因,中国的私立医院无法从公立医院里吸引医生过来。印尼对外国医生的管理仅有一条,那就是禁止医院聘请外国医生。Second, regulations can be treacherous. Gershu Paul, a former boss of Siloam, says that the time needed to obtain licences, permits and so on constrains growth. The rules sometimes stop companies investing at all. In 2012 Hong Kongs government requested bids to build two new hospitals. IHH and its local partners, which agreed to stipulations covering everything from the number of obstetric beds to the share of local patients, last year won the right to build one site. For the other site there was only one bid—which was rejected because it did not meet the governments requirements.其次,行业法规或许是不安的因素。西罗亚的前任老板Gershu Paul表示,申请营业执照、营业许可等等的一些条件都限制了医疗市场的增长。有时,一些条款完全让私人公司无法进行投资。2012年,香港政府为建立两所新医院发起了招标项目,而去年IHH和本地合伙人赢得了其中一所的承包权。他们答应了政府要求的从产科病床数到本地病人分享机制的所有条款。对于另外一所医院,在只有一家竞标商的情况下仍因为不满足政府要求而被拒绝。The third obstacle is uncertainty. Selling to the swelling middle class is no doddle: in such a new market, firms are finding it hard to gauge what people will pay for, say, a hip operation, or whether they will pay more for their aged parents care or for their childrens. Siloams private hospitals have six price tiers, an attempt to serve the many segments of Indonesias dynamic market, yet last year only 51% of their beds were filled. So far, the rich are the most dependable moneymakers. When IHH considers entering a market, it notes a countrys Gini coefficient, a measure of inequality: higher inequality implies wealthier patients willing to pay for treatment.最后一个问题是市场的不确定性。要在持续增长的中产阶级市场中取得成绩绝非易事:在这样的新市场里,医疗公司难以估测人们会为哪个项目买单,例如髋部手术,或者人们是否会为他们年迈的双亲和孩子付更高价格的医疗务。西罗亚的私立医院将医疗务分六个层次来定价,以尽可能多地囊括印尼多变的医疗市场。然而,去年该医院的床位仅达到了51%的使用率。到目前为止,富裕阶层是最可靠的盈利来源。当IHH公司考虑进入一个市场时,它会去关注国家的基尼系数:更高的贫富差距,意味着富裕的病人更愿意为高质量高价格的医疗务买单。Eventually some firms may prove adept at offering good, cheap treatment. Narayana Health, an Indian company, has tried to industrialise hospital operations to make care less pricey. But it remains to be seen how many private hospitals will count public-health services among their customers. In China, Phoenix has tested schemes in which the government pays it to run public hospitals. The government has said that public insurance may be used for private care, but implementation has been patchy. Of the 40 hospitals in Siloams plan for 2017, only the General in Tangerang will take fees from the government. Hospital companies will surely be part of Asias emerging health-care systems. How big a part is much less certain.最终部分公司或许能在优质廉价的医疗务领域如鱼得水。一家印度公司Narayana Health已经开始尝试将医院手术工业化,以降低医疗务的价格。然而,会有多少私立医院将公共医疗务作为自己的业务内容仍是个未知数。在中国,凤凰医疗集团已经着手进行了实验:政府付给私人公司去运营公立医院。政府已经表示了公共医疗保险或许也能用于私人医疗务,但该项目的实施困难重重。截至2017年为止的西罗亚公司40家医院里,只有文登镇的综合医院会收取政府的费用。可以肯定的是,医疗企业会参与到亚洲新兴的医疗系统当中来,而其规模有多大则无法确定。 /201405/299874

Its time to go again to the A Moment of Science mailbag.又到了抽取《科学一刻》信箱来信的时间了。A listener writes:一位听众这样写到:Dear A Moment of Science,亲爱的《科学一刻》栏目:I keep hearing about how diet soda is bad for you.我听说无糖汽水对身体有害。This is troubling, since I drink lots of the stuff because has zero calories.这可是件麻烦事,因为自从我听说无糖汽水不含热量后我就喝了很多。So, is diet soda really bad? And if so, why?所以说,无糖汽水真是有害的吗?如果是,那原因呢?Well, the most accurate we can offer to the first question is “maybe.”好了,我能给第一个问题最为精确的回答是“可能”。As for why? We dont really know.至于为什么?我实际上也不知道。To elaborate, a few studies have found links between sweetened beverages including fruit drinks and regular and diet soda and depression.确切的说,少有研究发现甜味饮料,包括果汁,含糖和无糖汽水与沮丧情绪有关。For example, one study by researchers at the National Institutes of Health looked at survey data from more than 260,000 people.例如,国立卫生研究院研究人员做了一项26万多人的调研,Those who drank at least four cans of regular soda per day were 30 percent more likely to have been diagnosed with depression.每天饮用超过四罐含糖汽水的人,就有30%被诊断出可能患有沮丧情绪症。People who drank diet soda were even more prone to depression, at 31 percent.31%饮用无糖汽水的人更容易情绪沮丧,And people who drank four or more cans of fruit drinks were the most vulnerable, being 51 percent more likely to be diagnosed with depression.饮用四罐或者更多果汁的人更加脆弱,高达51%的人可能会遭受沮丧情绪的困扰。To be clear, the study found an association, not necessarily a causal link.需要说明的是,这一研究找到的是相关性,而不是必然的因果联系。In other words, its not clear that drinking diet soda actually causes depression.换句话说,还不清楚无糖汽水是否真的会导致情绪沮丧。But its also possible that something in sweetened drinks does in fact cause or at least raise the risk for depression.但是,依然有可能的是甜饮料中的某些物质确实导致或者至少增加了情绪沮丧的风险。More research will help sort that out.更多研究将会持这一结论。So it seems reasonable to conclude that if you have a family history of depression, it may not be a bad idea to lay off sweetened drinks.因此,似乎有理由认为,如果有抑郁症家族史的人,停止饮用甜味饮料可能不是个坏主意。Even if studies have not proven that they trigger depression, there is a link.即使研究没有明它们能触发抑郁,但也据有相关性。 /201311/262949

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