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The Fraser Institute, Better Treatment, Better Care (6)

Better Treatment, Better Care (6)

percentage as long as we have a well-functioning universal system and

they'll want to be in the universal system for a chunk of their time we know

surgeons have some extra time we know there are surgeons in canada who can't

get operating time because of operating time limitations we know we have

unemployed orthopedic surgeons in canada graduating out of medical school

finishing their their their practical work they're ready to be surgeons they

can't get a placement in a hospital surgical test we have these additional

resources let's make better use of the resources that are already idle in

canada give patients a chance to access those resources in those physicians

additional time that's available and that physicians decide the right blend

there are constructs we can put in to limit how much time goes into each

system certainly a lot of countries have studied that but there's no reason to

say physicians have to be in or out and certainly the international experience

is that if you allow physicians to practice

you'll get some great benefit as a result well i'm trying to think of how

that would work in practice in canada so what i'm hearing you say is that you'd

have say orthopedic surgeon that's a good example they might have their own

surgical center their own private surgical center and they would do those

low acuity patients two or three days a week and then they'd have one day a week

whereas the more complicated patients that they do in the hospital and in both

they'd see publicly funded patients and in both they'd see private insured

patients and they would just move back and forth seamlessly between the do too

but able to do more surgeries in a given week

absolutely in fact to the canadian experience that surgeon may only have

one operating day a week in the public hospital so now they can operate every

thursday maybe thursday friday maybe they have 12 hours what do they do

outside of all those hours between their consults there may be more

time they can access there's also the labor leisure trade-off the surgeon may

be willing to do more surgical time than they currently do if that surgical time

was better funded which might be possible in the private sector

none of these are necessarily certain in terms of cost but what we do know is

that we have medical resources that are idle in canada surgical resources let's

put them to better use let's use the ors for longer hours even if that is

privately funded that doesn't change the number of public hours that are

available but it does change the number of patients that are being treated in

canada let me ask you the same question asked about sweden was there an aha

moment that we've got to do this thing differently or was there was there um

just an incremental change that happened over time because that notion of if you

you are high enough income you've got to pay for yourself

i i've i've advocated that in the past but i i wonder how it gained political

currency so that they were able to implement it can you shed some light on

that how do you make a big change like that i think as we look to australia and

we look around the developed world what we see is is progressive change uh

activity-based funding started to be experiments within the early 1980s we've

now come 30 years forward just about every developed nation has really moved

into activity-based funding in a meaningful way canada being one of a

very small subset of laggards i think what has happened in canada is we've

we've really embraced this false dichotomy this false economy has really

taken hold of the public and there's a belief that in canada

there's the canadian universal way which has its downsides it has its waiting

lists and its people suffering as a result but at least everyone's covered

or there's the american non-universal way where apparently and there's not

necessarily any truth to this but apparently people die in hospital

corridors and you have to swipe your credit card at the door of the ambulance

and people low income people die uninsured which is not true it's

actually not the lowest income it's it's the gap between not quite low enough

income to be covered by the public system but not quite

into the private scheme which is where a lot of the work has been done but this

misunderstood american system has been used

to scare canadians to embrace this government-managed system and certainly

there there have been political benefits to doing that there are some very

powerful voting blocks associated with the public system what we find around

the developed world those is countries are moving away from that model even the

uk years and years ago started moving away from the system that we embraced in

the 1960s they started moving towards activity-based funding to choice for

hospital care they've always had a private parallel healthcare system in

the united kingdom they just haven't necessarily had some of the other

constructs and so it's just a progressive change

over time as countries look to one another and say well hang on a second

that's really working over in sweden they've embraced activity-based funding

they're getting eleven percent more care for one percent less money if we look

problems to province the differential and cost efficiencies about 13

between activity-based funding and global budgets maybe this is something

we should do over here whereas in canada we seem to look over there go that's a

great idea let's do a little study over here but let's not be the american

system let's not change and that has really been to the

detriment of patients and taxpayers there's one last jurisdiction i want you

to get into and when we were talking about which ones we talked about we said

switzerland because i i liked the structure of switzerland and you

described it let's look at switzerland as a stretch goal because they do things

quite a bit differently than we do here but in some ways uh in an optimal way in

a lot of ways in an optimal way because it operates in my view a little bit more

like the traditional kind of insurances that we're used to for our homes or for

our cars and i think because it's a traditional insurance is structured that

way there must be some good reasons for it we haven't really talked much about

co-payments but perhaps we will when we when we understand a little bit more

about how sweden up our switzerland operates now i i do you've made the case

very well about activity-based funding being central i think you've made the

case very well as well about the need to have a mix of delivery models public

private non-profit and so we haven't talked as much about this

issue of co-payments why is it that putting some of your own skin in the

game some of your own money on the line what what does that prompt in changing

the way the system operates what happens what's the psychology there i i think it

really comes down to how encouraging patients to make a more

informed decision about when and where it's best to access the healthcare

system as a patient in canada in the canadian province i can go to the

emergency room i can go to my my general practitioner if i had a referral within

six months i could get out to my specialist to me as an individual

there's no cost difference between the three to the taxpayer there's a

meaningful difference between the three i even go to my pharmacist again another

meaningful difference but it doesn't matter where i go i pay

the same amount as a canadian i pay nothing the taxpayer covers the entire

bill for me when we go to a country like switzerland where we have a deductible

and that deductible is entirely funded by the patient up until a certain amount

is met after that there's a copay to a second amount now as an individual i'm

acutely aware of how much that emergency room might cost me relative to a general

practitioner i could go directly to the specialist if i'm absolutely convinced i

need to see my heart surgeon and i know he's more expensive than the gp but less

than the hospital i'm just going to go directly there but i'll be paying for it

so i can make that decision about whether it makes sense for me to go

direct go to my gp get the referral because it's my money now

and i'm spending it as an individual again trading off a dinner out a

starbucks versus healthcare never trading off shelter or food versus

health care that's where the protections have to be in place and when

catastrophic events occur again limiting the amount that is out of pocket because

that's where insurance comes into play but it's about encouraging people to

think about the varying costs of different areas of healthcare nurse

practitioners pharmacist practitioners who should i be seeing for my particular

healthcare condition switzerland is very interesting in that it actually allows

people to tailor their co-pay within the universal construct

if we think from the canadian perspective we are we are locked in this

old this old and now long left behind healthcare model where government is

monopolistic where government provides all the healthcare services we learn

okay base pretty much everyone in europe is has long ago abandoned or is moving

rapidly away from this sweden is maybe the first step we move into some private

provision of services not a lot we have activity-based funding we have some cost

sharing we have a parallel system australia is the next step we have a

little more cost sharing we have inducements to go in the private system

switzerland now it's private insurance within the universe so as a swiss

individual you go out into the marketplace and you purchase your

healthcare insurance policy from one of the universal insurers

universal insurers are not allowed to risk rate they can only rate based on

the area you live in and there are only three premium variations allowed within

an area and they must take all comers there is a standard program which has a

standard deductible and a standard copay after deductible but you can increase

that if you want and reduce your insurance premium if you're willing

individual to take on greater risk you can also go into managed care programs

which vary the deductible construct and limit your choice provider to bring your

premium down as an insured individual now you have

your private insurance you go to the health care provider either covered by

your insurance or provider of your choice depending on your policy you take

your standard rate card with you the provider gets paid the standard rate

card takes the standard amount for deductible and you can choose between

the private or the public hospital for profit of the non-profit it's entirely

up to you as an individual if you're not comfortable with the private for-profit

hospital not a problem go to the increase in the uncommon government

hospital but they're out there or go to the private hospital you get to select

and everyone in that system is very focused on the patient because the

money's always following the patient through the health care system and what

happens in a universal construct i'm an individual i can't afford my insurance

that's okay the government will provide me a transfer for the cost of my

insurance to go and seek it in the marketplace so even the low-income

Better Treatment, Better Care (6) より良い|治療|より良い|ケア Mejor tratamiento, mejor atención (6) 더 나은 치료, 더 나은 관리 (6) Лучшее лечение, лучший уход (6) Daha İyi Tedavi, Daha İyi Bakım (6) 更好的治疗，更好的护理 (6) より良い治療、より良いケア (6)

percentage as long as we have a well-functioning universal system and 割合|～する限り|長い|～する限り|私たち|持っている|一つの|||普遍的な|システム|そして percentage as long as we have a well-functioning universal system and 私たちに機能する普遍的なシステムがあれば、割合は

they'll want to be in the universal system for a chunk of their time we know 彼らは～だろう|欲しい|～すること|いる|～の中に|その|普遍的な|システム|～の間|一つの|一部|の|彼らの|時間|私たち|知っている ||||||||||período||||| they'll want to be in the universal system for a chunk of their time we know 彼らは自分たちの時間の一部を普遍的なシステムに置きたいと思うことがわかっています

surgeons have some extra time we know there are surgeons in canada who can't 外科医|持っている|いくつかの|余分な|時間|私たち|知っている|そこに|いる|外科医|～の中に|カナダ|～する人たち|できない surgeons have some extra time we know there are surgeons in canada who can't 外科医には余裕があることがわかっています。カナダには手術を行えない外科医がいます。

get operating time because of operating time limitations we know we have 得る|操作|時間|なぜなら|のため|||制限|私たち|知っている|私たち|持っている get operating time because of operating time limitations we know we have 運用時間の制限のために運用時間を取得する必要があります。

unemployed orthopedic surgeons in canada graduating out of medical school 失業した|整形外科の|外科医|の中で|カナダ|卒業する|出て|の|医学|学校 unemployed orthopedic surgeons in canada graduating out of medical school カナダでは、医学校を卒業した失業中の整形外科医がいます。

finishing their their their practical work they're ready to be surgeons they 終える|彼らの|彼らの|彼らの|実践的な|仕事|彼らは|準備ができている|するため|なる|外科医|彼ら finishing their their their practical work they're ready to be surgeons they 彼らは実習を終え、外科医になる準備が整っていますが、

can't get a placement in a hospital surgical test we have these additional できない|得る|一つの|配置|の中で|一つの|病院|外科的な|テスト|私たち|持っている|これらの|追加の can't get a placement in a hospital surgical test we hav e these additional 病院の外科テストに配置されることができません。これらの追加の問題があります。

resources let's make better use of the resources that are already idle in 資源|さあ|作る|より良い|使う|の|その|資源|それら|ある|すでに|使われていない|に resources let's make better use of the resources that are already idle in リソース、すでにアイドル状態にあるリソースをより良く活用しましょう

canada give patients a chance to access those resources in those physicians カナダ|与える|患者|一つの|機会|〜する|アクセスする|それらの|資源|に|それらの|医師 canada give patients a chance to access those resources in those physicians カナダでは、患者がその医師のリソースにアクセスできる機会を与えます

additional time that's available and that physicians decide the right blend 追加の|時間|それが|利用可能な|そして|それが|医師|決定する|その|正しい|組み合わせ additional time that's available and that physicians decide the right blend 利用可能な追加の時間と、医師が適切なバランスを決定します

there are constructs we can put in to limit how much time goes into each そこに|ある|構造|私たち|できる|置く|中に|〜するために|制限する|どれだけ|多くの|時間|行く|に|各 there are constructs we can put in to limit how much time goes into each 各リソースにどれだけの時間を費やすかを制限するための構造があります

system certainly a lot of countries have studied that but there's no reason to システム|確かに|一つの|多く|の|国々|持っている|学んできた|それを|しかし|それには|ない|理由|するために system certainly a lot of countries have studied that but there's no reason to システムは確かに多くの国がそれを研究してきましたが、理由はありません。

say physicians have to be in or out and certainly the international experience 言う|医師たち|持っている|しなければならない|いる|中に|または|外に|そして|確かに|その|国際的な|経験 say physicians have to be in or out and certainly the international experience 医師が参加する必要があるかどうかを言うことはできませんし、国際的な経験から言えば、

you'll get some great benefit as a result well i'm trying to think of how あなたは～するだろう|得る|いくつかの|大きな|利益|～として|一つの|結果|さて|私は～している|試みている|すること|考える|の|どのように you'll get some great benefit as a result well i'm trying to think of how その結果として素晴らしい利益が得られるでしょう。さて、どう考えようかと思っています。

that would work in practice in canada so what i'm hearing you say is that you'd それが|〜するだろう|働く|に|実践|に|カナダ|だから|何|私は〜している|聞いている|あなた|言う|〜である|それが|あなたは〜するだろう that would work in practice in canada so what i'm hearing you say is that you'd それはカナダで実際に機能するでしょう。つまり、あなたが言っているのは、あなたが

have say orthopedic surgeon that's a good example they might have their own 持つ|例えば|整形外科の|外科医|それは|一つの|良い|例|彼ら|かもしれない|持つ|彼らの|自分の have say orthopedic surgeon that's a good example they might have their own 整形外科医を持っているという良い例です。彼らは自分の

surgical center their own private surgical center and they would do those |||||||そして|彼ら|〜するだろう|行う|それらの surgical center their own private surgical center and they would do those 手術センター、つまり自分のプライベート手術センターを持っていて、彼らはそれらの

low acuity patients two or three days a week and then they'd have one day a week |||||||一つの|週|||||||| low acuity patients two or three days a week and then they'd have one day a week 低い重症度の患者を週に2、3日行い、そして週に1日は

whereas the more complicated patients that they do in the hospital and in both 一方で|その|より|複雑な|患者|その|彼らが|行う|中で|その|病院|そして|中で|両方 whereas the more complicated patients that they do in the hospital and in both 一方、彼らが病院で行うより複雑な患者は、両方のケースで

they'd see publicly funded patients and in both they'd see private insured 彼らは|見る|公的に|資金提供された|患者|そして|中で|両方|彼らは|見る|私的に|保険に入った they'd see publi cly funded patients and in both they'd see private insured 公的資金で支援されている患者と、両方のケースで

patients and they would just move back and forth seamlessly between the do too 患者|そして|彼らが|〜だろう|ただ|移動する|戻って|そして|前に|シームレスに|の間で|その|行う|も patients and they would just move back and forth seamlessly between the do too 民間保険の患者を見て、彼らはただスムーズに行き来していた

but able to do more surgeries in a given week しかし|できる|〜すること|行う|より多くの|手術|中で|一つの|特定の|週 but able to do more surgeries in a given week しかし、特定の週により多くの手術を行うことができた

absolutely in fact to the canadian experience that surgeon may only have 絶対に|に|事実|に|その|カナダの|経験|その|外科医|かもしれない|だけ|持つ absolutely in fact to the canadian experience that surgeon may only have カナダの経験において、外科医は公立病院で週に1回しか手術を行えないことがある。

one operating day a week in the public hospital so now they can operate every 1つの|手術|日|1つの|週|に|その|公立の|病院|だから|今|彼らは|できる|手術する|毎 one operating day a week in the public hospital so now they can operate every そのため、彼らは毎週木曜日に手術を行うことができるかもしれない。

thursday maybe thursday friday maybe they have 12 hours what do they do 木曜日|たぶん|木曜日|金曜日|たぶん|彼らは|持つ|時間|何|する|彼らは| thursday maybe thursday friday maybe they have 12 hours what do they do 木曜日と金曜日に、もしかしたら12時間の手術があるかもしれないが、

outside of all those hours between their consults there may be more 外|の|すべての|それらの|時間|の間に|彼らの|診察|そこに|かもしれない|ある|もっと outside of all those hours between their consults there may be more 彼らはその時間外に、コンサルトの合間に何をしているのだろうか。

time they can access there's also the labor leisure trade-off the surgeon may 時間|彼らが|できる|アクセスする|そこにある|も|その|労働|余暇|||その|外科医|かもしれない time they can access there's also the labor leisure trade-off the surgeon may アクセスできる時間には、外科医が労働と余暇のトレードオフを考慮する必要があります。

be willing to do more surgical time than they currently do if that surgical time である|意欲がある|すること|する|より多くの|外科的な|時間|よりも|彼らが|現在|している|もし|その|外科的な|時間 be willing to do more surgical time than they currently do if that surgical time 外科医は、現在行っているよりも多くの手術時間を費やす意欲があるかもしれませんが、その手術時間が

was better funded which might be possible in the private sector だった|より良い|資金提供された|それが|かもしれない|である|可能な|に|その|民間|セクター was better funded which might be possible in the private sector より良い資金提供を受けられる場合、これは民間部門で可能かもしれません。

none of these are necessarily certain in terms of cost but what we do know is どれも|の|これら|である|必ずしも|確実な|に関して|条件|の|コスト|しかし|何|私たちが|する|知っている|である none of these are necessarily certain in terms of cost but what we do know is これらのことはコストに関して必ずしも確実ではありませんが、私たちが知っているのは

that we have medical resources that are idle in canada surgical resources let's それ|私たちが|持っている|医療の|資源|それが|ある|使われていない|に|カナダ|外科的な|資源|しよう that we have medical resources that are idle in canada surgical resources let's カナダには使われていない医療資源がある、外科的資源をもっと有効に使おう

put them to better use let's use the ors for longer hours even if that is 置く|それらを|へ|より良い|使用|しよう|使用|その|手術室|のために|より長い|時間|たとえ|もし|それが|である put them to better use let's use the ors for longer hours even if that is 手術室をより長い時間使用しよう、たとえそれが私的資金であっても

privately funded that doesn't change the number of public hours that are ||それが|ない|変える|その|数|の|公共の|時間|それが|ある privately funded that doesn't change the number of public hours that a re それは公的な時間の数を変えるわけではないが

available but it does change the number of patients that are being treated in |しかし|それが|する|変える|その|数|の|患者|それが|ある|受けている|治療されている|に available but it does change the number of patients that are being treated in 治療される患者の数を変えることにはなる

canada let me ask you the same question asked about sweden was there an aha カナダ|させて|私に|聞く|あなたに|同じ|同じ|質問|聞かれた|について|スウェーデン|だった|そこに|一つの|アハ canada let me ask you the same question asked about sweden was there an aha カナダ、スウェーデンについて尋ねられたのと同じ質問をさせてください。何か「アハ」な瞬間がありましたか？

moment that we've got to do this thing differently or was there was there um moment that we've got to do this thing differently or was there was there um このことを違った方法でやらなければならないという瞬間があったのか、それとも時間をかけて少しずつ変化があったのか？

just an incremental change that happened over time because that notion of if you ||||||||||考え||| just an incremental change that happened over time because that notion of if you 高い収入があれば、自分で支払わなければならないという考え方があるからです。

you are high enough income you've got to pay for yourself you are high enough income you've got to pay for yourself

i i've i've advocated that in the past but i i wonder how it gained political 私は|私は〜してきた|私は〜してきた|主張してきた|それを|〜の中で|その|過去|しかし|私は|私は|不思議に思う|どのように|それが|得た|政治的な i i've i've advocated that in the past but ii wonder how it gained political 私は過去にそれを支持してきましたが、どのようにしてそれが政治的な影響力を持つようになったのか疑問に思います。

currency so that they were able to implement it can you shed some light on 通貨|だから|それが|彼らは|〜だった|できた|〜する|実行する|それを|できる|あなたは|照らす|いくつかの|光|〜について currency so that they were able to implement it can you shed some light on それを実施できるようになったのはどういうことか、少し教えていただけますか？

that how do you make a big change like that i think as we look to australia and それ|どのように|する|あなたは|作る|一つの|大きな|変化|のような|それ|私は|思う|〜として|私たちは|見る|〜に|オーストラリア|そして that how do you make a big change like that i think as we look to australia and ああいう大きな変化をどのように実現するのか、オーストラリアを見ていると、

we look around the developed world what we see is is progressive change uh |||||||||||||えっと we look around the developed world what we see is is progressive change uh 先進国を見回すと、私たちが見るのは進歩的な変化です。

activity-based funding started to be experiments within the early 1980s we've ||資金提供|始まった|〜すること|〜である|実験|〜の中で|その|初期の|1980年代|我々は〜してきた activity-based funding started to be experiments within the early 1980s we've 活動ベースの資金調達は1980年代初頭に実験が始まりました。

now come 30 years forward just about every developed nation has really moved 今|来た|年|前進して|ちょうど|約|すべての|発展した|国|持っている|本当に|移動した now come 30 years forward just about every developed nation has really moved 今、30年が経ち、ほぼすべての先進国が実質的に活動ベースの資金調達に移行しています。

into activity-based funding in a meaningful way canada being one of a 〜に|||資金提供|〜の中で|一つの|意味のある|方法|カナダ|〜であること|一つ|の|一つの into activity-based funding in a meaningful way canada being one of a カナダは遅れをとっている非常に小さなサブセットの一つです。

very small subset of laggards i think what has happened in canada is we've ||||遅れた人|私|思う|何が|持っている|起こった|〜で|カナダ|〜である|我々は〜してきた very small subset of laggards i think what has happened in canada is we've カナダで起こったことは、私たちが...

we've really embraced this false dichotomy this false economy has really 私たちは|本当に|受け入れた|この|偽の|二分法|この|偽の|経済|持っている|本当に we've really embrace d this false dichotomy this false economy has really 私たちはこの偽の二項対立を本当に受け入れてきました。この偽の経済は本当に

taken hold of the public and there's a belief that in canada 取った|握る|の|その|公共|そして|ある|一つの|信念|ということ|に|カナダ taken hold of the public and there's a belief that in canada 一般の人々に浸透しており、カナダには

there's the canadian universal way which has its downsides it has its waiting ある|その|カナダの|普遍的な|方法|それは|持っている|その|欠点|それは|持っている|その|待機 there's the canadian universal way which has its downsides it has its waiting カナダの普遍的な方法があるという信念があります。それには欠点があり、待機

lists and its people suffering as a result but at least everyone's covered ||||||||しかし|で|少なくとも|誰もが|カバーされている lists and its people suffering as a result but at least everyone's covered リストやその結果として苦しむ人々がいますが、少なくとも全員がカバーされています。

or there's the american non-universal way where apparently and there's not または|そこにある|その|アメリカの|||方法|どこで|明らかに|そして|そこにある|ない or there's the american non-universal way where apparently and there's not あるいは、アメリカの普遍的でない方法があって、どうやらそうらしいが、真実はないようだ

necessarily any truth to this but apparently people die in hospital 必ずしも|何かの|真実|に|これ|しかし|明らかに|人々|死ぬ|の中で|病院 necessarily any truth to this but apparently people die in hospital 必ずしも真実ではないが、どうやら人々は病院の廊下で亡くなる

corridors and you have to swipe your credit card at the door of the ambulance 廊下|そして|あなたは|持っている|する必要がある|スワイプする|あなたの|クレジット|カード|で|その|ドア|の|その|救急車 corridors and you have to swipe your credit card at the door of the ambulance そして、救急車のドアでクレジットカードをスワイプしなければならない

and people low income people die uninsured which is not true it's そして|人々|低い|収入|人々|死ぬ|無保険で|それは||ない|真実| and people low income people die uninsured which is not true it's そして、低所得者層の人々は無保険で亡くなるが、それは真実ではない

actually not the lowest income it's it's the gap between not quite low enough 実際に|ない|その|最低の|収入|それは||その|ギャップ|の間|ない|かなり|低い|十分な actually not the lowest income it's it's the gap between not quite low enough 実際には最低所得ではなく、十分に低くはないギャップです。

income to be covered by the public system but not quite 収入|するために|なる|カバーされる|によって|その|公共の|システム|しかし|ない|かなり income to be covered by the public system but not quite 公的制度でカバーされるには十分ではない所得ですが、十分ではありません。

into the private scheme which is where a lot of the work has been done but this に|その|私的な|スキーム|それは|である|どこで|一つの|多く|の|その|仕事|持っている|されてきた|された|しかし|この into the private scheme which is where a lot of the work has been done but this プライベートスキームには入っていないということです。ここで多くの作業が行われてきましたが、

to scare canadians to embrace this government-managed system and certainly 〜すること|脅かす|カナダ人|〜すること|受け入れる|この|||システム|そして|確かに to scare canadians to embrace this government-managed system and certainly カナダ人をこの政府管理のシステムを受け入れさせるために脅かすことができる、そして確かに

powerful voting blocks associated with the public system what we find around 強力な|投票|ブロック|関連した|〜と|その|公共の|システム|何|私たち|見つける|〜の周りで powerful voting blocks associated with the public system what we find around 強力な投票ブロックが公共システムに関連していることがわかる。私たちが見つけるのは、

the developed world those is countries are moving away from that model even the その|発展した|世界|それら|〜である|国々|〜している|移動している|離れて|〜から|その|モデル|さえ| the developed world those is countries are moving away from that model even the 先進国の周りでは、これらの国々がそのモデルから離れているということだ。

uk years and years ago started moving away from the system that we embraced in 英国|年|と|年|前|始めた|移動すること|離れて|から|その|システム|その|私たち|受け入れた|に uk years and years ago started moving away from the system that we embraced in イギリスは何年も前に、私たちが受け入れたシステムから離れ始めました。

the 1960s they started moving towards activity-based funding to choice for その|1960年代|彼ら|始めた|移動すること|向かって|||資金調達|への|選択|のための the 1960s they started moving towards activity-based funding to choice for 1960年代に、彼らは病院ケアのための選択肢として活動ベースの資金提供に移行し始めました。

hospital care they've always had a private parallel healthcare system in 病院|ケア|彼らは持っている|常に|持っていた|一つの|私的な|平行な|医療|システム|に hospital care they've always had a private parallel healthcare system in 彼らは常にイギリスにおいて、民間の並行医療システムを持っていました。

the united kingdom they just haven't necessarily had some of the other その|統一された|王国|彼ら|ただ|していない|必ずしも|持っていた|いくつかの|の|その|他の the united kingdom they just haven't necessarily had some of the other 彼らは単に他のいくつかのものを必ずしも持っていなかっただけです。

constructs and so it's just a progressive change 構築する|そして|だから|それは|ただ|一つの|進行中の|変化 constructs and so it's just a progressive change 構築されているので、これは単なる漸進的な変化です

over time as countries look to one another and say well hang on a second 超えて|時間|とき|国々|見る|に|一つ|他|そして|言う|さて|持つ|上で|一つの|秒 over time as countries look to one another and say well hang on a second 国々が互いに目を向けて、ちょっと待ってみようと言うのです

that's really working over in sweden they've embraced activity-based funding それは|本当に|機能している|超えて|に|スウェーデン|彼らは|受け入れた|||資金提供 that's really working over in sweden they've embraced activity-based funding スウェーデンでは、活動ベースの資金調達を受け入れており、実際に機能しています

they're getting eleven percent more care for one percent less money if we look 彼らは|得ている|11|パーセント|もっと|ケア|に対して|1|パーセント|少ない|お金|もし|私たちが|見る they're getting eleven percent more care for one percent less money if we look 彼らは1％少ないお金で11％多くのケアを受けています、もし私たちが見れば

problems to province the differential and cost efficiencies about 13 問題|〜するための|州|その|差|そして|コスト|効率|約 problems to province the differential and cost efficiencies about 13 問題は、約13の差異とコスト効率を提供することです。

between activity-based funding and global budgets maybe this is something 〜の間で|||資金提供|そして|グローバルな|予算|たぶん|これ|です|何か between activity-based funding and global budgets maybe this is something 活動ベースの資金提供とグローバル予算の間の違い、これは私たちがここで行うべきことかもしれません。

we should do over here whereas in canada we seem to look over there go that's a 私たち|〜すべき|する|〜の向こうに|ここで|一方で|〜の中で|カナダ|私たち|〜のように見える|〜すること|見る|〜の向こうに|そこに|行く|それは|一つの we should do over here whereas in canada we seem to look over there go that's a カナダでは、私たちはあちらを見て、ああ、これは素晴らしいアイデアだ、ここで少し研究をしましょうと言いますが、アメリカ人にはなりたくありません。

great idea let's do a little study over here but let's not be the american 素晴らしい|アイデア|〜しよう|する|一つの|小さな|研究|〜の向こうに|ここで|しかし|〜しよう|〜しない|なる|その|アメリカ人 great idea let's do a little study over here but let's not be the american

system let's not change and that has really been to the システム|〜しよう|〜ない|変える|そして|それが|持っている|本当に|〜であった|〜に|その system let's not change and that has really been to the システムは変えないようにしましょう、それが本当に患者や納税者にとって不利益になっています。

detriment of patients and taxpayers there's one last jurisdiction i want you 不利益|の|患者|そして|納税者|そこにある|一つ|最後の|権限|私|望む|あなた detriment of patients and taxpayers there's one last jurisdiction i want you 最後に話したい管轄が一つあります。私たちがどの管轄について話していたかというと、スイスについて話しました。

to get into and when we were talking about which ones we talked about we said |||そして|||||||||||| to get into and when we were talking about which ones we talked about we said なぜなら、私はスイスの構造が好きだからです。

switzerland because i i liked the structure of switzerland and you switzerland because ii liked the structure of switzerland and you あなたもそう思っているでしょう。

described it let's look at switzerland as a stretch goal because they do things 説明した|それ|さあ|見る|に|スイス|として|一つの|ストレッチ|目標|なぜなら|彼らは|する|物事 described it let's look at switzerland as a stretch goal because they do things スイスをストレッチゴールとして見てみましょう。彼らは私たちがここで行っていることとはかなり異なる方法で物事を行っていますが、ある意味では最適な方法で行っています。

quite a bit differently than we do here but in some ways uh in an optimal way in かなり|一つの|少し|違った風に|よりも|私たち|する|ここで|しかし|に|いくつかの|方法|ええと|に|一つの|最適な|方法| quite a bit differently than we do here but in some ways uh in an optimal way in 多くの点で最適な方法であると思います。なぜなら、私の見解では、彼らは私たちが自宅やその他のために慣れ親しんでいる伝統的な保険のように少しだけ運営しているからです。

a lot of ways in an optimal way because it operates in my view a little bit more 一つの|多く|の|方法|に|一つの|最適な|方法|なぜなら|それ|操作する|に|私の|見解|一つの|少し|少し|より a lot of ways in an optimal way because it operates in my view a little bit more

like the traditional kind of insurances that we're used to for our homes or for のように|その|伝統的な|種類|の|保険|その|私たちが|慣れている|に|のための|私たちの|家|または| like the traditional kind of insurances that we're used to for our homes or for

our cars and i think because it's a traditional insurance is structured that our cars and i think because it's a traditional insurance is structured that 私たちの車と、私は伝統的な保険がそのように構成されている理由がいくつかあると思います。

way there must be some good reasons for it we haven't really talked much about way there must be some good reasons for it we haven't really talked much about 私たちはそれについてあまり話していませんが、良い理由があるに違いありません。

co-payments but perhaps we will when we when we understand a little bit more co-payments but perhaps we will when we when we understand a little bit more 共済金についてはあまり話していませんが、スウェーデンやスイスの運営方法についてもう少し理解できたら、話すかもしれません。

about how sweden up our switzerland operates now i i do you've made the case about how sweden up our switzerland operates now ii do you've made the case さて、あなたがその理由を示してくれたことは理解しています。

very well about activity-based funding being central i think you've made the とても|よく|について|||資金提供|であること|中心|私は|思う|あなたは|作った|その very well about activity-based funding being central i think you've made the 活動ベースの資金調達が中心であることについて非常に良いことを言ったと思います。

case very well as well about the need to have a mix of delivery models public ケース|とても|よく|として|も|について|その|必要|すること|持つ|一つの|混合|の|提供|モデル|公共 case very well as well about the need to have a mix of delivery models public 公的、民間、非営利の配信モデルの組み合わせが必要であることについても、非常に良い主張をされました。

private non-profit and so we haven't talked as much about this private non-profit and so we haven't talked as much about this この問題についてはあまり話していませんでした。

issue of co-payments why is it that putting some of your own skin in the issue of co-payments why is it that putting some of your own skin in the 自己負担金を支払うことがなぜ重要なのか。

game some of your own money on the line what what does that prompt in changing ゲーム|いくつかの|の|あなたの|自分自身の|お金|上に|その|線|何||する|それ|促す|に|変化させる game some of your own money on the line what what does that prompt in changing 自分のお金を賭けるゲーム、それは何を促し、システムの運営方法をどう変えるのか

the way the system operates what happens what's the psychology there i i think it その|方法|その|システム|動作する|何|起こる|何が|その|心理|そこに|私|私|思う|それ the way the system operates what happens what's the psychology there ii think it 何が起こるのか、そこにある心理は何か、私はそれが

really comes down to how encouraging patients to make a more 本当に|来る|下る|へ|どのように|促すこと|患者|へ|作る|一つの|より really comes down to how encouraging patients to make a more 患者がいつどこで医療を受けるのが最適かについて、より

informed decision about when and where it's best to access the healthcare ||について|いつ|と|どこで|それが|最適|へ|アクセスする|その|医療 informed decision about when and where it's best to access the healthcare 情報に基づいた決定を下すことを促すことに帰着すると思います。

system as a patient in canada in the canadian province i can go to the システム|として|一人の|患者|に|カナダ|の|その|カナダの|州|私は|できる|行く|へ| system as a patient in canada in the canadian province i can go to the カナダの州における患者として、私は救急室に行くことができます。

emergency room i can go to my my general practitioner if i had a referral within 緊急|室|私は|できる|行く|へ|私の|私の|一般の|医師|もし|私が|持っていた|一つの|紹介状|の間に emergency room i can go to my my general practitioner if i had a referral within 紹介状があれば、一般開業医に行くことができます。

six months i could get out to my specialist to me as an individual 六|ヶ月|私は|できた|得る|出る|へ|私の|専門医|へ|私に|として|一人の|個人 six months i could get out to my specialist to me as an individual 6ヶ月以内に専門医に行くことができます。私にとって、

there's no cost difference between the three to the taxpayer there's a そこにある|ない|費用|違い|の間に|その|三つの|に|その|納税者|そこにある| there's no cost difference between the three to the taxpayer there's a 3つの間にコストの違いはありません。納税者にとっては、

meaningful difference between the three i even go to my pharmacist again another 意味のある|違い|の間に|その|三つ|私は|さえ|行く|に|私の|薬剤師|再び|別の meaningful difference between the three i even go to my pharmacist again another 3つの間に意味のある違いがあるが、私は再び薬剤師のところに行く。

meaningful difference but it doesn't matter where i go i pay 意味のある|違い|しかし|それ|ない|重要である|どこに|私は|行く|私は|支払う meaningful difference but it doesn't matter where i go i pay 意味のある違いがあるが、どこに行っても私は支払う。

the same amount as a canadian i pay nothing the taxpayer covers the entire その|同じ|金額|と同じ|一人の|カナダ人|私は|支払う|何も|その|納税者|支払う|その|全部の the same amount as a canadian i pay nothing the taxpayer covers the entire カナダ人と同じ金額を支払うが、私は何も支払わない。納税者が私のために全額を負担してくれる。

bill for me when we go to a country like switzerland where we have a deductible |||〜の時|私たちは|行く|に|一つの|国|のような|スイス|そこで|私たちは|持っている|一つの|自己負担額 bill f or me when we go to a country like switzerland where we have a deductible 私たちが自己負担額のあるスイスのような国に行くとき。

and that deductible is entirely funded by the patient up until a certain amount そして|その|自己負担額|です|完全に|賄われる|によって|その|患者|上|まで|一定の|特定の|金額 and that deductible is entirely funded by the patient up until a certain amount その控除額は、特定の金額に達するまで患者が全額負担します。

is met after that there's a copay to a second amount now as an individual i'm です|満たされる|後|それ|そこにある|一つの|コペイ|への|一つの|第二の|金額|今|として|一人の|個人|私は～です is met after that there's a copay to a second amount now as an individual i'm その後、2つ目の金額に対してコペイがあります。個人として、私はその救急治療室が一般医に比べてどれくらいの費用がかかるかを非常に意識しています。

acutely aware of how much that emergency room might cost me relative to a general 鋭く|知っている|の|どれだけ|多く|その|緊急|診療所|かもしれない|費用がかかる|私に|相対的に|に対して|一人の|一般の acutely aware of how much that emergency room might cost me relative to a general 私は、絶対に自分が専門医に直接行くべきだと確信している場合、専門医に直接行くことができます。

practitioner i could go directly to the specialist if i'm absolutely convinced i |私は|できる|行く|直接|に|その|専門医|もし|私は～です|絶対に|確信している|私は practitioner i could go directly to the specialist if i'm absolutely convinced i

need to see my heart surgeon and i know he's more expensive than the gp but less 必要がある|〜すること|会う|私の|心臓|外科医|そして|私は|知っている|彼は|より|高い|〜よりも|その|一般医|しかし|安い need to see my heart surgeon and i know he's more expensive than the gp but less 心臓外科医に会う必要があり、彼はGPよりも高いことは知っていますが、病院よりは安いです。

than the hospital i'm just going to go directly there but i'll be paying for it 〜よりも|その|病院|私は|ただ|行く|〜するために|行く|直接|そこ|しかし|私は〜するつもり|〜である|支払う|〜のために|それ than the hospital i'm just going to go directly there but i'll be paying for it 私は直接そこに行くつもりですが、自分で支払うことになります。

so i can make that decision about whether it makes sense for me to go だから|私は|できる|決める|その|決定|〜について|〜かどうか|それ|意味する|意味|〜にとって|私に|〜すること|行く so i can make that decision about whether it makes sense for me to go だから、私にとって行くことが意味があるかどうかを決めることができます。

direct go to my gp get the referral because it's my money now 直接|行く|〜するために|私の|一般医|得る|その|紹介状|なぜなら|それは|私の|お金|今 direct go to my gp get the referral because it's my money now 直接行ってGPに紹介状をもらうことにします。今は私のお金ですから。

and i'm spending it as an individual again trading off a dinner out a そして|私は|費やしている|それを|として|一つの|個人|再び|交換している|割り当てて|一つの|夕食|外で|一つの and i'm spending it as an individual again trading off a dinner out a そして、私は再び個人としてそれを使っており、外食とスターバックスを交換しています。

starbucks versus healthcare never trading off shelter or food versus スターバックス|対|医療|決して|交換している|割り当てて|住居|または|食べ物|対 starbucks versus healthcare never trading off shelter or food versus 医療とシェルターや食べ物を交換することは決してありません。

health care that's where the protections have to be in place and when 健康|ケア|それが|どこで|その|保護|持っている|する必要がある|ある|中に|場所|そして|いつ health care that's where the protections have to be in place and when それが保護が必要なところです。そして、

catastrophic events occur again limiting the amount that is out of pocket because |||再び|制限している|その|金額|それが|ある|外|の|ポケット|なぜなら catastrophic events occur again limiting the amount that is out of pocket because 壊滅的な出来事が再び発生したとき、自己負担額を制限することが重要です。

that's where insurance comes into play but it's about encouraging people to それが|どこで|保険|来る|中に|役割を果たす|しかし|それは|について|奨励すること|人々|〜すること that's where insuranc e comes into play but it's about encouraging people to それが保険が関与するところですが、人々に考えることを促すことが重要です。

think about the varying costs of different areas of healthcare nurse 考える|について|その|異なる|コスト|の|異なる|分野|の|医療|看護師 think about the varying costs of different areas of healthcare nurse さまざまな医療分野の異なるコストについて、看護師や

practitioners pharmacist practitioners who should i be seeing for my particular practitioners pharmacist practitioners who should i be seeing for my particular 薬剤師の専門家、私の特定の健康状態に対して誰に会うべきか。

healthcare condition switzerland is very interesting in that it actually allows healthcare condition switzerland is very interesting in that it actually allows スイスは非常に興味深い国で、実際にそれを許可しています。

people to tailor their co-pay within the universal construct 人々|〜するために|調整する|彼らの|||〜の中で|その|普遍的な|構造 people to tailor their co-pay within the universal construct 人々が普遍的な枠組みの中で自己負担額を調整すること

if we think from the canadian perspective we are we are locked in this もし|私たちが|考える|〜から|その|カナダの|視点|私たちが|〜である|私たちが|〜である|閉じ込められている|〜に| if we think from the canadian perspective we are we are locked in this カナダの視点から考えると、私たちはこの状況に閉じ込められています

old this old and now long left behind healthcare model where government is 古い|この|古い|そして|今|長い|去った|後ろに|医療|モデル|〜するところ|| old this old and now long left behind healthcare model where government is 古い、そして今は長い間置き去りにされた医療モデルで、政府が

okay base pretty much everyone in europe is has long ago abandoned or is moving まあ|基盤|かなり|ほとんど|みんな|の中で|ヨーロッパ|である|持っている|長い|前に|放棄した|または|である|移動している okay base pretty much everyone in europe is has long ago abandoned or is moving さて、ヨーロッパのほとんどの人々は、すでにこの方向を放棄したか、移行しています。

rapidly away from this sweden is maybe the first step we move into some private 急速に|離れて|から|これ|スウェーデン|である|おそらく|最初の|最初の|ステップ|私たち|移動する|に|いくつかの|民間の rapidly away from this sweden is maybe the first step we move into some private スウェーデンは、私たちがいくつかの民間サービスの提供に移行する最初のステップかもしれません。

provision of services not a lot we have activity-based funding we have some cost 提供|の|サービス|ない|一つの|多く|私たち|持っている|||資金提供|私たち|持っている|いくつかの|コスト provision of services not a lot we have activity-based funding we have some cost あまり多くはありませんが、私たちは活動ベースの資金提供を行っており、いくつかのコスト共有があります。

sharing we have a parallel system australia is the next step we have a 共有|私たち|持っている|一つの|平行な|システム|オーストラリア|である|次の|次の|ステップ|私たち|持っている| sharing we have a parallel system australia is the next step we have a オーストラリアは次のステップです。私たちはあるものを持っています。

little more cost sharing we have inducements to go in the private system little more cost sharing we have inducements to go in the private system もう少しコストシェアリングがあれば、私たちは民間システムに行くための誘因があります

switzerland now it's private insurance within the universe so as a swiss |||||||宇宙|||| switzerland now it's private insurance within th e universe so as a swiss スイスでは、今やユニバーサルな中で民間保険ですので、スイス人として

individual you go out into the marketplace and you purchase your individual you go out into the marketplace and you purchase your あなたは市場に出て、

healthcare insurance policy from one of the universal insurers healthcare insurance policy from one of the universal insurers ユニバーサル保険会社の1つから医療保険ポリシーを購入します

universal insurers are not allowed to risk rate they can only rate based on 普遍的な|保険会社|である|ない|許可されている|すること|リスク|評価する|彼らは|できる|だけ|評価する|基づいて| universal insurers are not allowed to risk rate they can only rate based on ユニバーサル保険会社はリスク評価を行うことができず、居住地域に基づいてのみ評価することができます。

the area you live in and there are only three premium variations allowed within その|地域|あなたが|住む|中に|そして|そこに|ある|だけ|三つの|保険料|変動|許可されている|内で the area you live in and there are only three premium variations allowed within 居住地域内で許可されている保険料の変動は3種類のみです。

an area and they must take all comers there is a standard program which has a 一つの|地域|そして|彼らは|しなければならない|受け入れる|全ての|来る人|そこに|ある|一つの|標準の|プログラム|それは|持っている|一つの an area and they must take all comers there is a standard program which has a すべての加入者を受け入れなければなりません。標準プログラムがあり、

standard deductible and a standard copay after deductible but you can increase ||||||||しかし|あなたは|できる|増やすこと standard deductible and a standard copay after deductible but you can increase 標準的な控除額と控除後の標準的なコペイがありますが、増額することができます。

that if you want and reduce your insurance premium if you're willing それ|もし|あなたが|欲しい|そして|減らす|あなたの|保険|保険料|もし|あなたが|準備ができている that if you want and reduce your insurance premium if you're willing もしあなたが望むなら、保険料を減らすことができます。

individual to take on greater risk you can also go into managed care programs 個人|〜すること|取る|上で|より大きな|リスク|あなたが|できる|も|行く|〜に|管理された|ケア|プログラム individual to take on greater risk you can also go into managed care programs 個人がより大きなリスクを引き受けることを望むなら、管理医療プログラムに参加することもできます。

which vary the deductible construct and limit your choice provider to bring your それらは|変わる|その|自己負担額|構造|そして|制限する|あなたの|選択|提供者|〜に|持ってくる|あなたの which vary the deductible construct and limit your choice provider to bring your これにより、自己負担額の構造が変わり、保険料を下げるために提供者の選択肢が制限されます。

premium down as an insured individual now you have 保険料|下げる|〜として|一つの|保険に加入している|個人|今|あなたが|持っている premium down as an insured individual now you have 保険に加入している個人として、今あなたには

your private insurance you go to the health care provider either covered by あなたの|プライベートな|保険|あなたは|行く|に|その|健康|ケア|提供者|どちらか|カバーされた|によって your private insurance you go to the health care provider either covered by あなたのプライベート保険では、保険でカバーされている医療提供者またはあなたの選択した提供者に行きます。

your insurance or provider of your choice depending on your policy you take あなたの|保険|または|提供者|の|あなたの|選択|依存する|に|あなたの|ポリシー|あなたは|持っていく your insurance or provider of your choice depending on your policy you take ポリシーに応じて、あなたは自分の標準料金表を持参します。提供者は標準料金表に基づいて支払いを受けます。

your standard rate card with you the provider gets paid the standard rate あなたの|標準の|料金|カード|と一緒に|あなたは|その|||||標準の|料金 your standard rate card with you the provider gets paid the standard rate 料金表は控除額の標準額を引き、あなたは選択肢の中から選ぶことができます。

card takes the standard amount for deductible and you can choose between カード|取る|その|標準の|金額|のために|自己負担額|そして|あなたは|できる|選ぶ|の間で card takes the standard amoun t for deductible and you can choose between

the private or the public hospital for profit of the non-profit it's entirely その|私立の|または|その|公立の|病院|のための|利益|の|その|||それは|完全に the private or the public hospital for profit of the non-profit it's entirely 営利法人の私立病院か非営利の公立病院かは完全にあなた次第です。

up to you as an individual if you're not comfortable with the private for-profit 上|まで|あなた|として|一つの|個人|もし|あなたは|ない|快適な|に|その|私立の|| up to you as an individual if you're not comfortable with the private for-profit もし営利の私立病院に不安があるなら、問題ありません。

hospital not a problem go to the increase in the uncommon government hospital not a problem go to the increase in the uncommon government 珍しい政府の病院に行くか、あるいは私立病院に行くことができます。あなたが選ぶことができます。

hospital but they're out there or go to the private hospital you get to select hospital but they're out there or go to the private hospital you get to select しかし、そこには選択肢があります。

and everyone in that system is very focused on the patient because the そして|みんな|に|その|システム|です|とても|集中している|に|その|患者|なぜなら| and everyone in that system is very focused on the patient because the そして、そのシステムのすべての人々は患者に非常に集中しています。

money's always following the patient through the health care system and what お金は|いつも|追いかけている|その|患者|を通して|その|健康|ケア|システム|そして|何が money's always following the patient through the health care system and what お金は常に患者を通じて医療システムに従っています。

happens in a universal construct i'm an individual i can't afford my insurance 起こる|に|一つの|普遍的な|構造|私は|一人の|個人|私は|できない|買う|私の|保険 happens in a universal construct i'm an individual i can't afford my insurance 普遍的な構造では、私は個人であり、保険を負担できません。

that's okay the government will provide me a transfer for the cost of my それは|大丈夫|その|政府|するだろう|提供する|私に|一つの|移転|のために|その|費用|の| that's okay the government will provide me a transfer for the cost of my それは大丈夫です。政府が私の費用のために移転を提供してくれます。

insurance to go and seek it in the marketplace so even the low-income 保険|〜へ|行く|そして|探す|それ|〜の中で|その|市場|だから|さえ|その|| insurance to go and seek it in the marketplace so even the low-income 保険を探しに市場に行くこと、だから低所得者層でさえも

PAR_TRANS:gpt-4o-mini=6.18 PAR_CWT:AvJ9dfk5=8.43 ja:AvJ9dfk5 openai.2025-02-07 ai_request(all=78 err=2.56%) translation(all=153 err=3.92%) cwt(all=2017 err=18.20%)