Ageing in Japan 老龄化在日本

Home help 居家协助

The government is struggling to curb the rising cost of health care 政府正努力控制日益上涨的医保费用

curb: 控制；限制，约束；抑制

struggle:奋斗; 搏斗; 努力; 争取;

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，国立市

labour: （因为劳累）吃力的；费力的

fortnightly：两周地

infarction: （组织）梗塞

phlegm: 痰

close-knit: 关系紧密的；紧密团结的；组织严密的

在东京的卫星镇国立市一个小公寓里，茨木保之（Yasuyuki Ibaraki音译）躺在阳光灿烂的房里，合着眼，费力地呼吸着。每两周会从当地诊所上门访问的医生宫崎之夫（Yukio Miyazaki音译）怀疑他所剩时间不多了：脑部因脑梗受损，消化系统长有肿瘤，并且无法吞咽或说话。他的妻子丽子通过一条通向胃部的软管为他喂食，并为他清除喉咙的痰。“他来自一个关系融洽的家庭，也是个安静的人，所以我认为他待在这里比待在医院更好。”她说道，一边啜着绿茶，吃着葡萄。

长句：he has brain damage from a cerebral infarction, a tumour in his digestive system and is unable to swallow or talk. 注意这里并列的关系：he has and is， has的宾语是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. 卫星镇，在大城市周围地区，为分散中心城市(母城)的人口和工业而新建或扩建的具有相对独立性的城镇。

日本名字使用以下网址翻译：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; 转而; 轮流地; 相应地;

budget: [vt/vt]制订预算，计划（开支）

levy: 征税; 征（兵）; 索取; 发动（战争）;

debt service: 还本付息，在既定时期内还本付息所需的现金

日本的预期寿命是全球最长，高达84岁。对民众这是个好消息，但这也意味着在人口结构，老年人占比前所未有的高。整整28%的日本人年龄大于65岁，而在美国，这一数字是15%，德国是21%。更多的老年人，相应地，意味着高更的医疗费用。去年，政府为医疗卫生和护理制定的预算是15兆日元（1380亿美元，或者说总支出的15%），这还排除了政府从医疗保险计划中征收的费用。由于公共债务是GDP的250%，还本付息又进一步消耗了24%的支出，政府正在拼命寻找降低支出的方法。它认为在家照护老人是最好的选项之一。

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: 奖金，津贴；加价；附加费

municipality: 市，自治市；市政府，市政当局

parlance: 说法，用语

所有的日本人每月都得额外补贴公共保险计划，或是通过雇主、或是通过市政当局。作为回报，他们被赋予权利，可以获得公立和私立医院医生的治疗和药物，尽管他们还必须支付这笔治疗费用的一部分（用美国的说法“共同支付”），这笔费用有上限。2000年，日本引入一项新的公共保险计划，针对65岁以上人士的长期护理，参加的人必须从40岁起开始交费。工作原理是一样的。额外补贴和共同支付的费用覆盖了服务费用的约60%；政府则支付了其余费用。老年人占了支出的最大部分。政府认为75岁以上人士在医疗健康的平均年支出是942,000日元，其他人仅需要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: 关于…的，和…比较起来;

按老龄化国家的标准，日本在医疗费用方面控制得相当好——东京圣路加国际大学的池上直树（Naoki Ikegami）表示。政府设置了服务费用来降低成本（尽管这鼓励了服务提供商去执行些并非必要的步骤，来赚取更多的钱：相对于人口来说，日本CT扫描仪的数量比全球其他国家都要多）。这还促进了更廉价的基因药物的使用。

背景：圣路加国际大学（英文：St. Luke's International University，日文平假名：せいるかこくさいだいがく）简称圣路加、圣路加大，是一所位于东京都中央区的日本私立大学。其前身为1920年创立的圣路加国际医院附属高等护士学校，1964年更名为圣路加看护大学，2014年更名为圣路加国际大学。目前设有看护学部（本科），看护学研究科（硕士、博士）。

Life-giving, budget-busting

给予生命，打破预算

bust: 击碎；打破；弄坏

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: （价值或数量）慢慢增加，逐渐上升

无论如何，在经合组织内，日本的医疗卫生占GDP比例已经逐渐上升到第六位，仅次于法国和美国，但领先于意大利和韩国——另外两个老龄化国家。问题不仅在于老年人数量在增加，人均支出也在上升，因为随着寿命延长，许多人患有阿尔茨海默症和糖尿病等疾病。

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.

日本多年来都在推广居家照护模式，但现在力度更大。考虑到日本的平均住院时间是例如荷兰这样国家的三倍，这个政策会尤其有益。卫生部认为一百万人将在2025年接受居家照护——现在总数的1.5倍。专为家庭服务的特殊护理单位数量由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：（选定的）专家小组；嵌板，镶板；仪表板；操纵台

oblige: 责成；强迫，迫使；be obliged to: 必须; 不得不; 只得;

discharge: 允许…离开；（尤指）允许…出院；（根据法庭决议）释放

去年，一个政府的专家小组提出建议，提高医生上门访问的收费，并将通过视频会议服务进行的咨询设为合法。它同时还提议了一些新措施来促进居家照护。例如说，医院在让病人出院时，应该被强制和社会服务机构交谈。

长句：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指金钱数量

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：医疗设施

go about: 处理; 到处走动; 流传; 改变方向;

某些市政当局已经在社区提供了优秀的照护服务。尾道是个小镇，历史悠久到甚至比国家的建立时间都要早，它就是其中之一。尾道市的医疗设施能进行15分钟的“护理会议”，与医生、护士、家庭成员甚至牙医讨论他们将如何照顾病人。“以前医院要告诉病人回家是非常困难的，因为没有居家照护系统。”医生片山尚（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）痴呆

Matsudo: 松户

respite: 暂停；暂时中止；暂时缓解

tend to sb/sth: 照料，照顾；关心

针对特定疾病的社区照护能力也在提高。以老年痴呆为例，老年痴呆现在影响了5百万日本人（人口的4%），这个数字在2030年底将达到6%到7%。不同于仅仅提供机构式照护和医药服务，某些镇，例如东京东北部的松户，就建造了咖啡厅，在此为病人和护理者们提供建议和陪伴。日间护理中心为照顾老年家属的家庭提供了喘息休息的场所，它们也很常见。人们还能做很多其他事情：仅仅13%的日本人在家中逝世，尽管大部分日本人都说他们想要如此。

长句：

(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：几种常见的护理方式：

institutional care: 机构照护主要是透过兴建集合式照顾设施，由行政、护理、照顾及社会工作者等人员进驻，集中照顾老人。

Community care: 社区照护

home care: 居家照护

Day centres: 日间护理中心

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；改进

incidence: 事件；（事件的）发生率

但更广泛的居家护理尚不足以使日本能负担起疗健康费用。安倍晋三（Shinzo Abe）政府想要修改社会保障系，它认为这样可以帮助降低医疗费用。举例来说，提高退休年龄可以让人们保持积极性，身体更健康，交税时间更多。政府还希望，能够降低对老年人产生影响的疾病的发生率，但这些疾病的根源在于他们在年轻时的行为。“我们倾向于将关注放在老年人身上，但我们需要关注年轻来防止疾病。”财政部的西川和美表示。他尤其关注于向人们提供更多关于糖尿病病因的信息（日本的糖尿病发病率正在上升），或是哪些锻炼可以阻止老年痴呆症进一步发展。

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.

人们也极有可能要为医疗健康付出更多费用。在75年以上老人中，许多人的共同支付占比仅为10%，相比之下，其他人都需要30%。“政府应该将这笔费用翻倍至20%，以此开始。” 国家健康保险组合连合会（健保连）的董事总经理川本重文表示。“有些老年人没有收入来源，但许多人有” 他断言。政府应该将一些项目移除出覆盖范围，他表示，例如非处方药。同时，视线回到国立市，之夫医生与丽子谈论她丈夫的情况。她担心丈夫的情况有所恶化，她说，并且在医生上门访问间隙非常焦距。之夫医生承诺，从现在起，他每周都会上门探访。

Kenporen：けんぽれん 健康保険組合連合会