Name: 偏鄉醫療為什麼會失敗，看看美國吧！ (How America is failing its rural hospitals)
Uploaded: 2025-06-17T21:01:20.000Z
Duration: 7 min 56 s

This pin represents St. Mark's Hospital in Texas.

這枚徽章代表著德州的聖馬克醫院。

分詞構句

Starting in 2020, the hospital struggled to pay its mortgage debt.

從 2020 年開始，醫院一直在努力償還抵押貸款債務。

程度副詞

In February 2023, the hospital board voted to shutter inpatient services, meaning overnight care, and cut nearly half the staff.

2023 年 2 月，醫院董事會投票決定關閉住院病人服務，即過夜護理，並裁員近一半。

By October 2023, the entire hospital shut down.

到 2023 年 10 月，整個醫院關閉。

Now, when EMS responds to a 911 call in the area...

現在，當急救中心接到該地區的 911 報警電話時...

They're now forced to pick up that patient and either drive them an hour to an hour and 15 minutes into Austin,

現在，他們不得不去接病人，要麼開車一小時到一小時十五分鐘去奧斯汀，

or 30 minutes or so to come down to Columbus, or another 30 minutes to come down to Howitzville.

要麼花 30 分鐘左右去哥倫布，要麼再花 30 分鐘去豪茨維爾。

This story is becoming increasingly common in small towns across the United States.

這樣的故事在美國各地的小鎮越來越常見。

It's being called the rural hospital crisis.

And experts warn it's about to get much worse, with some states like Texas at risk of losing nearly half of all small town hospitals in the near future.

專家警告說，情況會變得更糟，在不久的將來，德克薩斯州等一些州將面臨失去近一半小鎮醫院的風險。

In small rural communities, the hospital is the healthcare system.

在農村小社區，醫院就是醫療系統。

And so if the hospital closes, patients basically can lose access to all healthcare.

如果醫院關閉，病人基本上就會失去所有的醫療服務。

So why are so many rural hospitals in the U.S. shutting down?

那麼，為什麼美國有這麼多鄉村醫院關閉呢？

And what does it really mean for these communities?

這對這些社區究竟意味著什麼？

Before we get into it, it's worth noting that this is the second of three videos we're doing on how emergency help gets to remote places.

在我們開始介紹之前，值得注意的是，這是我們正在製作的關於如何向偏遠地區提供緊急救援的三個影片中的第二個。

Rural areas in the U.S. often struggle to get the same services as more populated regions.

美國的農村地區往往難以獲得與人口較多地區相同的服務。

We wanted to explore what some of those challenges look like and what might be done to make things better.

我們希望探討其中的一些挑戰是什麼樣子的，以及如何才能讓事情變得更好。

And we're grateful to our sponsor, T-Mobile, for supporting this video.

我們非常感謝贊助商 T-Mobile 對這部影片的支持。

T-Mobile has invested billions to bring 5G coverage across the U.S., and they're committed to supporting first responders and their families with exclusive savings.

T-Mobile 已投資數十億美元在全美範圍內實現 5G 覆蓋，並承諾以獨家優惠支持急救人員及其家屬。

You can learn more about that in the link below.

你可以透過下面的連結瞭解更多資訊。

T-Mobile didn't dictate the content of this video, but they did make our reporting possible.

T-Mobile 沒有決定這部影片的內容，但他們使我們的報導成為可能。

Well, the simple reason that rural hospitals are losing money is because they're not paid enough by health insurance plans to cover the cost of delivering services in rural areas.

鄉村醫院虧損的原因很簡單，因為醫療保險計劃支付給他們的費用不足以支付在鄉村地區提供服務的成本。

Hospitals can make money in a few different ways, but the largest one is fairly obvious, fees for their services, inpatient and outpatient care.

醫院可以通過幾種不同的方式賺錢，但最大的一種方式相當明顯，那就是收取服務費、住院費和門診費。

While small-town hospitals have less patients than their urban counterparts, though, they are typically reimbursed at the same rate for the same services, which is a problem because...

雖然小城鎮醫院的病人比城市醫院少，但它們通常以相同的費率獲得相同的服務補償，這是一個問題，因為...

Cost per patient is higher in small, rural hospitals.

在小型鄉村醫院，每名患者的成本更高。

And that largely has to do with fixed cost.

It's just extremely costly to run a hospital.

Medical equipment and building maintenance aren't less expensive because a hospital has less patients.

醫療設備和建築維護的成本並不會因為醫院的病人減少而降低。

And doctors and nurses are typically salaried.

而醫生和護士通常都是拿工資的。

It's not like they're getting paid by the patient.

All in all, in terms of fixed costs, it's not cheaper to treat a heart attack or a broken arm in rural Texas than it is in Dallas or Austin.

總而言之，就固定成本而言，在德州農村地區治療心臟病或手臂骨折並不比在達拉斯或奧斯汀便宜。

Every dollar we spend, we may get reimbursed 30 cents.

我們每花一美元，就可能得到 30 美分的補償。

This can get kind of confusing, so I'm gonna simplify it.

這可能會讓人有點困惑，所以我要簡化一下。

There are really two ways a hospital can get reimbursed for care.

醫院可以通過兩種方式報帳醫療費用。

Private insurance, like, you know, Blue Cross Blue Shield, Cigna United, and public insurance, like Medicare and Medicaid.

私人保險，如藍十字藍盾、諾、美聯航，以及公共保險，如聯邦醫療保險和聯邦醫療補助。

Data from the KFF found that Medicare covered a larger share of inpatient care in rural areas,

KFF 的數據發現，聯邦醫療保險為農村地區的住院病人提供了更大份額的醫療服務，

which, according to the American Hospital Association, only reimbursed 83 cents for every dollar spent on inpatient care.

而根據美國醫院協會的數據，住院病人每花費 1 美元，醫療保險只報帳 83 美分。

That's collectively billions of dollars lost year after year.

年復一年，這就是數十億美元的集體損失。

The trouble is, for many small-town hospitals, this is often the best-case scenario.

問題是，對於許多小鎮醫院來說，這往往是最好的情況。

Major reason many small rural hospitals are losing money is not Medicare and it's not Medicaid.

許多小型鄉村醫院虧損的主要原因不是醫療保險，也不是醫療補助。

It's commercial insurance plans, private insurance plans that are underpaying.

支付不足的是商業保險計劃和私人保險計劃。

When it comes time to renegotiate a contract, private insurers kind of have small rural hospitals in a chokehold.

當需要重新談判合約時，私人保險公司就會扼住小型鄉村醫院的咽喉。

Contracts with insurers are typically renegotiated every year to account for things like inflation.

與保險公司的合同通常每年都要重新談判，以考慮通貨膨脹等因素。

One of these insurance companies delayed for about eight months.

其中一家保險公司拖延了大約八個月。

Which meant the hospital was losing money on reimbursement.

這意味著醫院在報帳方面虧損了。

They equated that to about $10 million in revenue that they lost.

他們認為這相當於損失了大約 1000 萬美元的收入。

A major health system might be able to afford $10 million in losses here or there, but a small hospital barely breaking even certainly can't.

大型醫療系統或許可以承受這裡或那裡的 1000 萬美元損失，但一家勉強收支平衡的小醫院肯定無法承受。

And a newer plan called Medicare Advantage is creating an entirely new set of issues.

而一項名為 "醫療保險優勢 "的新計劃則帶來了一系列全新的問題。

More than half of the Medicare beneficiaries in the country are now on Medicare Advantage plans.

目前，全國一半以上的醫療保險受益人参加了醫療保險優勢計劃。

It's essentially a Medicare option through a private insurer and they reimburse less, sometimes not at all, and overall, way less reliably.

這基本上是通過私人保險公司進行的醫療保險選擇，他們的報帳額度較低，有時甚至完全不報帳，總體而言，可靠性較低。

So a traditional Medicare patient, you get paid in 14 days.

所以，傳統的醫療保險病人可在 14 天內獲得賠付。

醫療保險優勢計劃可能是 45、60 或 90。

Pair that with impending cuts to programs like Medicare and Medicaid, and this crisis is likely about to get much worse.

再加上聯邦醫療保險和聯邦醫療補助等計劃即將被削減，這場危機很可能會變得更加嚴重。

As small town hospitals sink further into the red, they're forced to make really difficult decisions.

隨著小鎮醫院進一步陷入虧損，他們不得不做出非常艱難的決定。

When a hospital is struggling financially, they're often forced to cut services.

當醫院陷入財務困境時，往往會被迫削減服務。

One of the first to go is usually labor and delivery.

This report found that 25% of rural hospitals have had to drop OB services since 2011.

該報告發現，自 2011 年以來，25% 的鄉村醫院不得不放棄產科服務。

Cancer care is also being cut at alarming rates.

癌症治療也在以驚人的速度削減。

Nearly half the hospitals that once offered chemotherapy in Texas had to shut down the service between 2014 and 2022.

在 2014 年至 2022 年期間，德州曾提供化療服務的醫院有近一半不得不關閉化療服務。

This leaves millions of people without access to care.

這使得數百萬人無法獲得醫療服務。

And why we keep hearing the metaphor, desert.

為什麼我們總是聽到 "沙漠 "這個比喻？

Hundreds of thousands of rural Ohioans live in some form of healthcare desert. 5.6 million women in this country live in a maternity desert.

俄亥俄州數十萬農村居民生活在某種形式的醫療沙漠中。全國有 560 萬婦女生活在孕產荒漠中。

County leaders call this region a healthcare desert.

縣上司稱這一地區為醫療沙漠。

For decades now, rural hospitals have been sort of in this perennial state of crisis.

幾十年來，鄉村醫院一直處於危機四伏的狀態。

And Congress has been trying to solve it for decades with a range of programs.

幾十年來，美國國會一直試圖通過一系列計劃來解決這個問題。

So for example, the Critical Access Hospital payment program has been around since the 90s.

例如，Critical Access Hospital 付款計劃從 1990 年代就開始實施了。

It reimburses hospitals using an approach called cost-based reimbursement at 101% of their Medicare costs.

它採用一種稱為基於成本的報帳方法，按照醫療保險成本的 101% 向醫院進行報帳。

Critical Access hospitals have to meet a certain criteria, though, so the program doesn't work for every hospital.

不過，Critical Access 醫院必須滿足一定的標準，所以該計劃並不適用於每家醫院。

Another option is a program called the Rural Emergency Hospital Program.

另一個選擇是名為 "農村急救醫院計劃 "的項目。

It allows a hospital to get a very large, multi-million dollar annual grant from the federal government, but only if it eliminates inpatient services.

它允許醫院每年從聯邦政府獲得數百萬美元的鉅額撥款，但前提是醫院必須取消住院服務。

並不是每個人都喜歡這個想法。

Why you're helping it in the first place is to avoid losing services, so to say.

可以這麼說，你一開始為什麼要幫助它，就是為了避免失去服務。

We'll only help you if you eliminate services, kind of counter to the whole idea that you're trying to go and you're trying to achieve.

只有在你取消服務的情況下，我們才會幫助你，這有點違背了你想要去實現的整個想法。

What rural hospitals might need are more options.

鄉村醫院可能需要更多的選擇。

The rural communities are so heterogeneous and their population health needs are so heterogeneous.

農村社區的情況千差萬別，居民的健康需求也各不相同。

And so I think at the end of the day, the decision is governed by the patients you serve.

所以我認為最終還是要由你所服務的病人來決定。

We tend to take our local hospitals for granted because they've been there since we were a kid.

我們往往認為當地的醫院是理所當然的，因為它們從我們小時候就一直存在。

They've been there when our parents were kids.

當我們的父母還是孩子的時候，他們就已經在那裡了。

I mean, you always hear if a town loses their hospital, the town starts to die.

我的意思是，你總是聽說，如果一個小鎮失去了醫院，這個小鎮就會開始消亡。

Not only do you lose a major employer of the county or the city in these small rural settings,

在這些小農村地區，你不僅失去了一個縣或市的主要僱主，

you're also losing one of the only healthcare-type institutions that maybe within an hour, maybe an hour and a half.

還失去了一個小時或一個半小時車程內唯一的醫療保健機構。

The simplest solution really is to pay the rural hospitals enough to be able to cover the cost of delivering their services.

其實，最簡單的解決辦法就是向鄉村醫院支付足夠的費用，使其能夠支付提供服務的成本。

It's simply a matter of every health insurance plan paying adequately for the cost of delivering services in rural areas.

這只是每個醫療保險計劃為在農村地區提供服務的成本支付足夠費用的問題。

We want to try to continue this model of not having a national healthcare system, but allowing us to treat ourselves in the different parts of the United States where we're at, locally, rurally.

我們希望延續這種模式，不建立全國性的醫療保健系統，而是允許我們在美國的不同地區、地方和鄉村進行治療。

We have to see a different type of reimbursement model.

我們必須看到一種不同的報帳模式。

字幕列表影片播放

偏鄉醫療為什麼會失敗，看看美國吧！ (How America is failing its rural hospitals)

struggle

critical

access

eliminate