Ageing in Japan 老齡化在日本

Home help?居家協(xié)助

The government is struggling to curb the rising cost of health care 政府正努力控制日益上漲的醫(yī)保費用

curb: 控制；限制，約束；抑制

struggle:奮斗; 搏斗; 努力; 爭取;

In a sunny room in a small apartment in the Tokyo satellite town of Kunitachi lies Yasuyuki Ibaraki, eyes closed and breathing laboured. Yukio Miyazaki, his doctor, who visits fortnightly from a local clinic, suspects that he does not have much time left: he has brain damage from a cerebral infarction, a tumour in his digestive system and is unable to swallow or talk. Reiko, his wife, feeds him through a tube to his stomach and clears phlegm from his throat. “He is from a close-knit family and is a quiet man, so I think it is better for him to be here rather than in a hospital,” she says, over green tea and grapes.

Kunitachi: 日本地名，國立市

labour: （因為勞累）吃力的；費力的

fortnightly：兩周地

infarction: （組織）梗塞

phlegm: 痰

close-knit: 關系緊密的；緊密團結的；組織嚴密的

在東京的衛(wèi)星鎮(zhèn)國立市一個小公寓里，茨木保之（Yasuyuki Ibaraki音譯）躺在陽光燦爛的房里，合著眼，費力地呼吸著。每兩周會從當?shù)卦\所上門訪問的醫(yī)生宮崎之夫（Yukio Miyazaki音譯）懷疑他所剩時間不多了：腦部因腦梗受損，消化系統(tǒng)長有腫瘤，并且無法吞咽或說話。他的妻子麗子通過一條通向胃部的軟管為他喂食，并為他清除喉嚨的痰?！八麃碜砸粋€關系融洽的家庭，也是個安靜的人，所以我認為他待在這里比待在醫(yī)院更好?！彼f道，一邊啜著綠茶，吃著葡萄。

長句：he has brain damage from a cerebral infarction, a tumour in his digestive system and is unable to swallow or talk. 注意這里并列的關系：he has and is， has的賓語是brain damage, a tumour

背景：satellite town: A satellite town or satellite city is a concept in urban planning that refers essentially to smaller metropolitan areas which are located somewhat near to, but are mostly independent of larger metropolitan areas. 衛(wèi)星鎮(zhèn)，在大城市周圍地區(qū)，為分散中心城市(母城)的人口和工業(yè)而新建或擴建的具有相對獨立性的城鎮(zhèn)。

日本名字使用以下網(wǎng)址翻譯：http://www.hipenpal.com/tool/japanese-names-search-and-converter-in-traditional-chinese.php?vp=&sp=&lang=&od=e&startchk=OK&keyword=reiko&to=%E6%AA%A2%E7%B4%A2&lastname=checked&malename=checked&femalename=checked

Life expectancy in Japan is the highest in the world, at 84. This is good news for its people, but means that an ever-higher share of the population is elderly. Fully 28% of Japanese are older than 65, compared with 15% of Americans and 21% of Germans. More old people, in turn, means higher health-care costs. Last year the government budgeted ￥15trn ($138bn, or 15% of its total expenditure) for health care and nursing, excluding the charges it levies for the public health-insurance scheme. With public debt at 250% of gdp, and debt service consuming a further 24% of spending, the government is looking desperately for ways to cut costs. It reckons caring for people at home is one of its best options.

in turn: 依次; 轉而; 輪流地; 相應地;

budget: [vt/vt]制訂預算，計劃（開支）

levy: 征稅; 征（兵）; 索取; 發(fā)動（戰(zhàn)爭）;

debt service: 還本付息，在既定時期內還本付息所需的現(xiàn)金

日本的預期壽命是全球最長，高達84歲。對民眾這是個好消息，但這也意味著在人口結構，老年人占比前所未有的高。整整28%的日本人年齡大于65歲，而在美國，這一數(shù)字是15%，德國是21%。更多的老年人，相應地，意味著高更的醫(yī)療費用。去年，政府為醫(yī)療衛(wèi)生和護理制定的預算是15兆日元（1380億美元，或者說總支出的15%），這還排除了政府從醫(yī)療保險計劃中征收的費用。由于公共債務是GDP的250%，還本付息又進一步消耗了24%的支出，政府正在拼命尋找降低支出的方法。它認為在家照護老人是最好的選項之一。

All Japanese pay a monthly premium to the public insurance scheme, either through their employer or the local municipality. In return they are entitled to treatment and drugs from public and private doctors and hospitals, although they must also pay a portion of the cost of treatment (a co-payment, in American parlance), subject to a cap. In 2000 Japan introduced an additional public insurance scheme for long-term care for those over 65, into which people must pay from the age of 40. It works the same way. The premiums and co-payments cover around 60% of the cost of the services provided; the government pays for the rest. And it is the old who cost the most. The government reckons that the average annual cost of health care for someone over 75 is ￥942,000, compared with just ￥221,000 for everyone else.

premium: 獎金，津貼；加價；附加費

municipality: 市，自治市；市政府，市政當局

parlance: 說法，用語

所有的日本人每月都得額外補貼公共保險計劃，或是通過雇主、或是通過市政當局。作為回報，他們被賦予權利，可以獲得公立和私立醫(yī)院醫(yī)生的治療和藥物，盡管他們還必須支付這筆治療費用的一部分（用美國的說法“共同支付”），這筆費用有上限。2000年，日本引入一項新的公共保險計劃，針對65歲以上人士的長期護理，參加的人必須從40歲起開始交費。工作原理是一樣的。額外補貼和共同支付的費用覆蓋了服務費用的約60%；政府則支付了其余費用。老年人占了支出的最大部分。政府認為75歲以上人士在醫(yī)療健康的平均年支出是942,000日元，其他人僅需要221,000日元。

By the standards of ageing nations, Japan has managed to curb medical costs fairly well, says Naoki Ikegami of St Luke’s International University in Tokyo. The government sets fees for services to keep costs down (although that encourages providers to perform unnecessary procedures to make more money: Japan has more ct scanners relative to its population than any other country). It has also promoted the use of generic drugs, which are cheaper.

relative to: 關于…的，和…比較起來;

按老齡化國家的標準，日本在醫(yī)療費用方面控制得相當好——東京圣路加國際大學的池上直樹（Naoki Ikegami）表示。政府設置了服務費用來降低成本（盡管這鼓勵了服務提供商去執(zhí)行些并非必要的步驟，來賺取更多的錢：相對于人口來說，日本CT掃描儀的數(shù)量比全球其他國家都要多）。這還促進了更廉價的基因藥物的使用。

背景：圣路加國際大學（英文：St. Luke's International University，日文平假名：せいるかこくさいだいがく）簡稱圣路加、圣路加大，是一所位于東京都中央?yún)^(qū)的日本私立大學。其前身為1920年創(chuàng)立的圣路加國際醫(yī)院附屬高等護士學校，1964年更名為圣路加看護大學，2014年更名為圣路加國際大學。目前設有看護學部（本科），看護學研究科（碩士、博士）。

Life-giving, budget-busting

給予生命，打破預算

bust: 擊碎；打破；弄壞

Nonetheless, the country has crept up to sixth place in the OECD’s ranking of the share of gdp spent on health care, behind France and America, but ahead of Italy and South Korea—two other ageing countries (see chart on next page). It is not just that the number of old people is increasing; spending per person is rising, too, as people live longer with diseases like Alzheimer’s and diabetes.

creep up: （價值或數(shù)量）慢慢增加，逐漸上升

無論如何，在經(jīng)合組織內，日本的醫(yī)療衛(wèi)生占GDP比例已經(jīng)逐漸上升到第六位，僅次于法國和美國，但領先于意大利和韓國——另外兩個老齡化國家。問題不僅在于老年人數(shù)量在增加，人均支出也在上升，因為隨著壽命延長，許多人患有阿爾茨海默癥和糖尿病等疾病。

Japan has promoted home care for many years, but it is pushing it harder now. The policy is especially beneficial given that the average hospital stay in Japan is three times longer than in the Netherlands, for instance. The health ministry reckons that 1m people will receive care at home in 2025—one-and-a-half times the current total. The number of special nursing units exclusively for home visits has risen from 7,473 in 2014 to 10,418 in 2018.

日本多年來都在推廣居家照護模式，但現(xiàn)在力度更大?？紤]到日本的平均住院時間是例如荷蘭這樣國家的三倍，這個政策會尤其有益。衛(wèi)生部認為一百萬人將在2025年接受居家照護——現(xiàn)在總數(shù)的1.5倍。專為家庭服務的特殊護理單位數(shù)量由2014年的7473上升到2018年的10418。

Last year a government panel suggested raising the amount doctors are paid for home visits and making consultations conducted via video-conferencing services eligible, too. It also proposed new rules to encourage care at home. Hospitals should be obliged to talk to social services when they discharge a patient, for example.

panel：（選定的）專家小組；嵌板，鑲板；儀表板；操縱臺

oblige: 責成；強迫，迫使；be obliged to: 必須; 不得不; 只得;

discharge: 允許…離開；（尤指）允許…出院；（根據(jù)法庭決議）釋放

去年，一個政府的專家小組提出建議，提高醫(yī)生上門訪問的收費，并將通過視頻會議服務進行的咨詢設為合法。它同時還提議了一些新措施來促進居家照護。例如說，醫(yī)院在讓病人出院時，應該被強制和社會服務機構交談。

長句：Last year a government panel suggested (raising the amount doctors are paid for home visits) and (making consultations conducted via video-conferencing services eligible, too. )

主干：suggested A and B

A: raising the amount. Doctors are paid amount for home visits. amount指金錢數(shù)量

B: making consultations conducted via video-conferencing services eligible, too. 主干：make sth eligible. sth: consultations (conducted via video-conferencing services)

Some municipalities are already offering good care in the community. Onomichi, a small provincial city that is even older than the country as a whole, is one. Its medical facilities have 15-minute “care conferences” with doctors, nurses, family members and even dentists, to discuss how they will go about looking after people. “It used to be hard for hospitals to tell a patient to return home as there was no system for that; that has changed,” says Hisashi Katayama, a doctor.

Onomichi: [地名] [日本] 尾道;

medical facilities：醫(yī)療設施

go about: 處理; 到處走動; 流傳; 改變方向;

某些市政當局已經(jīng)在社區(qū)提供了優(yōu)秀的照護服務。尾道是個小鎮(zhèn)，歷史悠久到甚至比國家的建立時間都要早，它就是其中之一。尾道市的醫(yī)療設施能進行15分鐘的“護理會議”，與醫(yī)生、護士、家庭成員甚至牙醫(yī)討論他們將如何照顧病人。“以前醫(yī)院要告訴病人回家是非常困難的，因為沒有居家照護系統(tǒng)?！贬t(yī)生片山尚（Hisashi Katayama）表示。

Community care for specific diseases is improving, too. Take dementia, which currently affects 5m Japanese (4% of the population), and will afflict 6-7% by 2030. Rather than provide only institutional care and medicine, some towns, such as Matsudo, north-east of Tokyo, have set up cafés to offer advice and companionship to patients and their carers. Day centres that give respite to families tending to elderly relatives are common. Much more could be done: only 13% of Japanese die at home, although most say they want to.

dementia: （尤指老年性）癡呆

Matsudo: 松戶

respite: 暫停；暫時中止；暫時緩解

tend to sb/sth: 照料，照顧；關心

針對特定疾病的社區(qū)照護能力也在提高。以老年癡呆為例，老年癡呆現(xiàn)在影響了5百萬日本人（人口的4%），這個數(shù)字在2030年底將達到6%到7%。不同于僅僅提供機構式照護和醫(yī)藥服務，某些鎮(zhèn)，例如東京東北部的松戶，就建造了咖啡廳，在此為病人和護理者們提供建議和陪伴。日間護理中心為照顧老年家屬的家庭提供了喘息休息的場所，它們也很常見。人們還能做很多其他事情：僅僅13%的日本人在家中逝世，盡管大部分日本人都說他們想要如此。

長句：

(Rather than provide only institutional care and medicine, some towns, such as Matsudo, north-east of Tokyo, have set up cafés to offer advice and companionship to patients and their carers.

Day centres (that give respite to families tending to elderly relatives) are common.

背景：幾種常見的護理方式：

institutional care: 機構照護主要是透過興建集合式照顧設施，由行政、護理、照顧及社會工作者等人員進駐，集中照顧老人。

Community care: 社區(qū)照護

home care: 居家照護

Day centres: 日間護理中心

But more widespread home care will not be enough to make Japan’s health care affordable. The government of Shinzo Abe wants to revamp the social-security system, which it reckons will help reduce health-care costs. Raising the retirement age, for example, will keep people active, healthier and paying tax for longer. The government also wants to try to reduce the incidence of diseases that affect older people, but have their origins in behaviour at a younger age. “We have tended to focus on the old, but we need to look at the younger to prevent disease,” says Kazumi Nishikawa of the economy ministry. He is particularly focused on giving people more information on what causes diabetes, which is on the rise in Japan, or exercises that can stem the progression of dementia.

revamp: 修改；改進

incidence: 事件；（事件的）發(fā)生率

但更廣泛的居家護理尚不足以使日本能負擔起療健康費用。安倍晉三（Shinzo Abe）政府想要修改社會保障系，它認為這樣可以幫助降低醫(yī)療費用。舉例來說，提高退休年齡可以讓人們保持積極性，身體更健康，交稅時間更多。政府還希望，能夠降低對老年人產(chǎn)生影響的疾病的發(fā)生率，但這些疾病的根源在于他們在年輕時的行為?！拔覀儍A向于將關注放在老年人身上，但我們需要關注年輕來防止疾病?！必斦康奈鞔ê兔辣硎尽Ｋ绕潢P注于向人們提供更多關于糖尿病病因的信息（日本的糖尿病發(fā)病率正在上升），或是哪些鍛煉可以阻止老年癡呆癥進一步發(fā)展。

People are likely to have to pay more for health care, too. Co-payments for many of those over 75 are only 10%, compared with 30% for everyone else. The government should start by doubling that to 20%, says Shigefumi Kawamoto, managing director of Kenporen, the national federation of health-insurance societies. “Some elderly people don’t have resources, but many do,” he avers. The government could exclude some items from coverage, he says, such as over-the-counter drugs. Meanwhile, back in Kunitachi, Dr Miyazaki talks to Reiko about her husband’s condition. She is worried that her husband is getting worse, she says, and is anxious between visits. The doctor promises to come weekly from now on.

人們也極有可能要為醫(yī)療健康付出更多費用。在75年以上老人中，許多人的共同支付占比僅為10%，相比之下，其他人都需要30%?！罢畱搶⑦@筆費用翻倍至20%，以此開始?！?國家健康保險組合連合會（健保連）的董事總經(jīng)理川本重文表示?！坝行├夏耆藳]有收入來源，但許多人有” 他斷言。政府應該將一些項目移除出覆蓋范圍，他表示，例如非處方藥。同時，視線回到國立市，之夫醫(yī)生與麗子談論她丈夫的情況。她擔心丈夫的情況有所惡化，她說，并且在醫(yī)生上門訪問間隙非常焦距。之夫醫(yī)生承諾，從現(xiàn)在起，他每周都會上門探訪。

Kenporen：けんぽれん 健康保険組合連合會