Funding social care: an international comparison

Lessons for Britain from other countries

原文：

To judge by the record of successive British governments, reforming social

care is almost impossible. But other rich countries have managed to grasp

the nettle. Doing so, notes Natasha Curry of the Nuffield Trust, a think-tank,

usually requires a government to make a compelling case for change. It also

requires some difficult policy choices.

从历届英国政府的记录来看，改革社会保障几乎是不可能的。但是其他富裕国家已经设法迎难而上。智囊团纳菲尔德信托基金会的娜塔莎·库里指出，这样做通常需要政府做出令人信服的改变。这也需要一些艰难的政策选择。

学习：

successive：连续的；接连的；依次的；

grasp the nettle：果断处理难题；勇敢面对困难；迎难而上；直面挑战

原文：

Most countries accept that some of the costs of care should be shared by the

state. Voluntary private insurance comes up short, in part because the young

do not think about their old age until it is too late and because the old find

that premiums are too high. Out-of-pocket costs can quickly spiral, leaving

poorer folk dependent on relatives or charity. The state can help in two main

ways: through general taxation or social insurance.

大多数国家都同意国家应该分担部分医疗费用。自愿私人保险的不足，部分是因为年轻人不考虑他们的老年，直到为时已晚，也因为老年人发现保费太高。自付费用可能会迅速上升，让穷人依赖亲戚或慈善机构。国家可以通过两种主要方式提供帮助:一般税收或社会保险。

学习：

private insurance：商业保险；私人保险

premiums：保险费

out-of-pocket：自费；现款支付；自掏腰包

relatives:亲戚

原文：

England uses general taxation to fund a threadbare safety net. Nordic

countries are more generous. Aside from the Netherlands, Norway, Sweden

and Denmark spend the most on long-term care as a share of GDP in the

OECD, a club of rich countries. Funds are raised locally, topped up with government

grants to iron out regional variations, and then ring-fenced. Costs are

contained by reducing levels of residential care, which is dearer than care at

home. But the Nordic countries still face problems of financial sustainability,

says Ana Llena-Nozal, a health economist at the OECD. Cost pressures mean

that care has been cut back in recent years; variation between regions is

increasing.

英格兰用一般税收来资助一个陈旧的安全网。北欧国家更慷慨。除了荷兰，挪威、瑞典和丹麦在长期护理上的花费占GDP的比例在经合组织(一个富裕国家的俱乐部)中最高。资金在当地筹集，由政府拨款补足以消除地区差异，然后专款专用。通过降低比家庭护理更贵的住宿护理水平来控制成本。但是经合组织的健康经济学家Ana Llena-Nozal说，北欧国家仍然面临着财政可持续性的问题。成本压力意味着近几年医疗费用已经削减；地区之间的差异正在增加。

学习：

threadbare：美 [ˈθrɛdbɛr] 破旧的；磨薄的；陈腐的；老一套的；

aside from：除…之外还有；

iron out：解决；消除；处理

top up: 通过额外的资金来补充或增加现有的资金

Top up: 在这个上下文中，“top up” 指的是通过额外的资金来补充或增加现有的资金。例如，当地方政府筹集的资金不足以满足需求时，中央政府会通过额外拨款来补充这些资金，以确保所有地区的资金水平相对均衡。

例子：

• 英文: The local council raised some money for the project, but the government had to top it up with additional grants.
• 中文: 当地政府为这个项目筹集了一些资金，但政府必须通过额外拨款来补充这些资金。

costs are contained：控制成本

ring-fenced: 资金专门用于特定用途

Ring-fenced: “Ring-fenced” 指的是将资金专门用于特定用途，并确保这些资金不会被挪用或用于其他目的。在本文中，指的是用于长期护理的资金是专门分配的，不会被用于其他开支。

例子：

• 英文: The charity’s donations are ring-fenced for education programs, so they cannot be used for other activities.
• 中文: 这家慈善机构的捐款是专门用于教育项目的，因此不能用于其他活动。

cut back：缩减；削减；减少（开支、使用或消耗）

原文：

In social-insurance schemes, individuals—and often employers, too—make

mandatory contributions that entitle them to a basic level of care when they

need it. In Germany, which introduced its social-insurance scheme in 1995,

these contributions amount to 3.4% of workers’ income. Those without

children must pay more. Japan’s system was reformed in 2000; there,

contributions start from the age of 40 (in part because many people start to

care for ageing relatives at about that time) and also tap pensioners’ income.

在社会保险计划中，个人——通常也包括雇主——必须缴纳一定的费用，这样他们就可以在需要的时候享受基本的医疗服务。在1995年引入社会保险计划的德国，这些缴款相当于工人收入的3.4%。那些没有孩子的人必须付出更多。日本的制度在2000年进行了改革；在那里，缴费从40岁开始(部分原因是许多人在那个时候开始照顾年迈的亲属),同时也利用养老金领取者的收入。

学习：

entitle：授权；赋予权利；使享有权利

原文：

Yet this model, too, has its challenges. As people live longer and costs rise,

social-insurance contributions are usually still topped up with taxation.

When Japan’s costs rose too quickly, the government cut bespoke care for

the lowest categories of need and replaced it with prevention programmes

and exercise classes. By incentivising people in need to take cash instead of

services, the German system still relies on families—usually women—to

provide care at home, notes José-Luis Fernández of the London School of

Economics.

然而，这种模式也有其挑战。随着人们寿命的延长和成本的上升，社会保险缴款通常仍由税收补足。当日本的成本上升过快时，政府削减了最低需求类别的定制护理，代之以预防项目和健身课程。伦敦经济学院的何塞·路易斯·费尔南德斯指出，通过鼓励有需要的人接受现金而不是服务，德国的医疗体系仍然依赖家庭——通常是女性——来提供家庭护理。

学习：

bespoke：订制的；订做的；专门制作的；量身订做的；

原文：

Almost every system requires out-of-pocket payments, on top of what has

been paid by taxes or contributions. Often they are tied to some kind of

means test. Australia, with a tax-based system, uses a mix of means-tested

fees and charges for services for the elderly, though lifetime costs and annual

“hotel costs” for bed and board in care homes are capped. (A parallel system

for those with disabilities is more generous.) France tapers the level of state

funded support according to income.

几乎每一个系统都需要自付费用，除此之外还要缴纳税款或捐款。他们通常会接受某种经济状况调查。澳大利亚是一个以税收为基础的体系，对老年人服务采用一系列经过经济情况调查的费用和收费，尽管养老院的终身费用和年度食宿“酒店费用”有上限。(针对残疾人的平行系统更加慷慨。)法国根据收入逐渐减少国家资助的支持水平。

学习：

contributions：捐赠；捐款；

means test：经济状况调查；收入调查；财务状况审查；

taper：美 [ˈteɪpər] 渐渐收窄；逐步缩小；逐渐减少

原文：

If the Labour government is to get serious about reforming social care, two

lessons stand out. One is that it must articulate the case for change. For

Germany, it was a matter of equity after reunification. For Japan, it was to

ease the burden on relatives, many of whom were dropping out of the labour

market. The other is that context matters. Nordic citizens are used to high

taxes and a more fulsome welfare system. Social insurance offers greater

transparency on the contract between the individual and the state; that may

be a better way to persuade Britons to shell out. ■

如果工党政府认真对待社会保障改革，有两点值得注意。其中之一是，它必须阐明变革的理由。对德国来说，这是统一后的公平问题。对日本来说，这是为了减轻亲属的负担，他们中的许多人已经退出了劳动力市场。另一个是背景很重要。北欧公民已经习惯了高税收和更令人满意的福利制度。社会保险为个人和国家之间的契约提供了更大的透明度；这可能是说服英国人掏钱的更好方法。■

学习：

articulate：表达；明确表述

reunification：重新统一；重新团结

ease the burden：减轻负担

fulsome： 全面的，丰厚的

Fulsome 在这个上下文中指的是“全面的”或“丰厚的”，表示北欧国家的福利系统不仅范围广泛，而且提供了充足的支持。这种福利体系不仅涉及到社会保险，还包括广泛的社会服务和支持。

例子：

• 英文: The politician gave a fulsome apology, covering every aspect of the issue and acknowledging all the mistakes.
• 中文: 这位政客作出了全面的道歉，涵盖了问题的各个方面，并承认了所有的错误。

shell out：支付大笔款项；付款；不情愿地付钱；

后记

2024年9月4日10点48分于上海。