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背景介紹:

新冠肺炎疫情的蔓延給世界各國(guó)人民的生命安全和身體健康帶來(lái)嚴(yán)重威脅。病毒的肆虐需要中美兩國(guó)合作面對(duì)，共同克服眼前的困難。在此背景下，美國(guó)美中關(guān)系全國(guó)委員會(huì)和北京大學(xué)國(guó)家發(fā)展研究院邀請(qǐng)中國(guó)和美國(guó)的頂級(jí)專(zhuān)家開(kāi)啟中美健康二軌對(duì)話特別公共活動(dòng)，對(duì)公共健康改革、隔離政策與醫(yī)療衛(wèi)生供給等方面的問(wèn)題進(jìn)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(diǎn)】

中國(guó)采取了全國(guó)上下嚴(yán)格的管控措施應(yīng)對(duì)新冠疫情

首先，中國(guó)采取了全國(guó)上下嚴(yán)格的管控措施應(yīng)對(duì)新冠疫情。在強(qiáng)大的中央政府指揮下，采取了封鎖、檢測(cè)、追蹤和隔離阻斷等一系列措施。更重要的是，各級(jí)地方政府緊跟這些措施，通過(guò)嚴(yán)密社區(qū)網(wǎng)絡(luò)管理，在供應(yīng)側(cè)（企業(yè)）和需求側(cè)（家庭）同時(shí)發(fā)力干預(yù)，得以實(shí)現(xiàn)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(guó)家文化的差異

其次，非政府因素對(duì)健康的結(jié)果也很重要。不同國(guó)家的人們?cè)谏缃痪嚯x等自我行為防控上也有明顯的差異，背后的主因之一來(lái)自于不同國(guó)家文化間的差異，比如個(gè)人對(duì)健康和財(cái)富之間的權(quán)衡、生命的長(zhǎng)短和生活的質(zhì)量取舍上的選擇差異。國(guó)家間的文化差異帶來(lái)行為上的差異，從而也影響抗疫的健康結(jié)果。比如，為了抗擊疫情，中國(guó)和印度都推行了非常嚴(yán)格的政府管控，但是兩國(guó)人們的自身防控行為很不相同，這對(duì)兩國(guó)的不同健康結(jié)果有著重要的影響。另一個(gè)有趣的例子是中國(guó)和日本。中國(guó)的政府規(guī)定防控力度更加強(qiáng)大，日本則更多強(qiáng)調(diào)和依靠公民的自律行為，也在經(jīng)濟(jì)和健康兩個(gè)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(yī)院的運(yùn)用

第三，中國(guó)充分利用公立醫(yī)院的優(yōu)勢(shì)來(lái)應(yīng)對(duì)疫情。為了抗擊病毒，政府在全國(guó)范圍內(nèi)動(dòng)員了42000多名醫(yī)務(wù)人員加入到湖北武漢抗擊病毒的第*，同時(shí)從全國(guó)衛(wèi)生系統(tǒng)大量抽調(diào)醫(yī)療技術(shù)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(yīng)收盡收，幾乎所有確診病例都在公立醫(yī)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(guān)于中國(guó)疫情防控過(guò)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(yī)院能夠得到優(yōu)質(zhì)的治療服務(wù)。一個(gè)有待探究的問(wèn)題是，將所有患者集中醫(yī)院救治是否具有經(jīng)濟(jì)學(xué)的成本有效？根據(jù)國(guó)內(nèi)外的大量流病研究結(jié)論，新冠患者80%以上屬于輕癥，其中大多可在基層醫(yī)療機(jī)構(gòu)和社區(qū)衛(wèi)生服務(wù)中心得以很好的照料康復(fù)。假如新冠疫情以后每年成為人類(lèi)的“?？汀?，并且發(fā)生規(guī)模涉及多個(gè)地區(qū)，那么在醫(yī)院收治所有患者的醫(yī)療模式不僅可能存在可持續(xù)性問(wèn)題，同時(shí)還會(huì)閑置大量基層醫(yī)療機(jī)構(gòu)的人財(cái)物資源。

第二，在全國(guó)大幅傾斜配置醫(yī)療和財(cái)政資源集中應(yīng)對(duì)COVID-19患者的同時(shí)，許多其他疾病的患者由于大多醫(yī)院強(qiáng)行要求關(guān)閉或減少相關(guān)科室而不能獲得及時(shí)治療。從醫(yī)療資源配置效率和社會(huì)福利的綜合考慮，我們應(yīng)該在COVID-19造成的可見(jiàn)生命損失和其他主要死亡殺手的無(wú)形生命損失之間進(jìn)行更科學(xué)、更理性的決策權(quán)衡。作為參考，根據(jù)2020年全球疾病負(fù)擔(dān)上半年的數(shù)據(jù)可知，迄今為止，全球COVID-19的死亡人數(shù)平均每天約為3500人，而人類(lèi)面臨病死風(fēng)險(xiǎn)的“頭號(hào)殺手”心血管疾病的日均致死率高達(dá)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(guó)是技術(shù)領(lǐng)先者，中國(guó)是追趕者，美國(guó)更為關(guān)注技術(shù)竊取和知識(shí)產(chǎn)權(quán)保護(hù)等問(wèn)題，這在情理之中，也可以理解。但為了更好促進(jìn)兩國(guó)之間良好而有效的合作，美國(guó)如果能夠制定出更為透明和易于遵循、執(zhí)行的指南，這對(duì)兩國(guó)和整個(gè)世界都會(huì)更有益處。兩國(guó)研究人員因此可以通過(guò)訪問(wèn)計(jì)劃、教育計(jì)劃和其他舉措繼續(xù)進(jìn)行交流學(xué)習(xí)。

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(guān)于指導(dǎo)方針“About the Guideline”

我非常關(guān)注當(dāng)前不利于中美兩國(guó)以及全球合作的政治環(huán)境。但無(wú)論喜歡與否，我們的社會(huì)都由政府管理。因此，我再次呼吁兩國(guó)政府見(jiàn)面、對(duì)話和商談，能夠形成更為透明、易于遵循和實(shí)施的行動(dòng)指南。這樣，我們就能向前邁進(jìn)，更好推進(jìn)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(guó)恩，北大博雅特聘教授、教育部長(zhǎng)江學(xué)者特聘教授、北大國(guó)發(fā)院教授，北大中國(guó)衛(wèi)生經(jīng)濟(jì)研究中心主任。劉國(guó)恩教授研究領(lǐng)域?yàn)榻】蹬c發(fā)展經(jīng)濟(jì)學(xué)，國(guó)家醫(yī)療體制改革，以及醫(yī)藥經(jīng)濟(jì)學(xué)。