Keynote Address at the Ministerial Meeting on Universal Health Coverage: the Post-2015 Challenge在全民健康覆盖问题部长级会议上的主旨发言：2015 年后的挑战Dr Margaret Chan, Director-General of the World Health Organization世界卫生组织总干事 陈冯富珍博士Singapore, 10 February 2015新加坡，2015 年 2 月 10 日Your Excellency, Prime Minister Lee Hsien Loong, Minister Gan, honourable ministers, distinguished experts, colleagues in public health, ladies and gentlemen,李显龙总理阁下、颜部长阁下、尊贵的各位部长、尊敬的各位专家、公共卫生界的各位同事、女士们、先生们，It is a great honour to address a ministerial meeting on universal health coverage in Singapore, a city-state with an inclusive health system known for its affordable excellence. Last year, Bloombergs second annual ranking of countries with the most efficient health care placed Singapore at the top.我深表荣幸能在新加坡的这次全民健康覆盖问题部长级会议上发言，这个城市国家以其出色且负担得起的包容性卫生系统而闻名。去年，在彭博社关于卫生保健最具成效的国家的第二次排名中，新加坡名列榜首。WHO also places Singapore at the top for key health indicators, especially maternal and infant mortality, two of the most sensitive indicators of a well-functioning health system. Through foresighted and visionary planning, Singapore achieved first-rate health care, with outstanding health outcomes, at a cost lower than in any other high-income country in the world.世卫组织也将新加坡排在关键卫生指标的前列，尤其是在孕产妇和婴儿死亡率方面，这两个指标是运转良好的卫生系统的最敏感指标。新加坡通过其高瞻远瞩的规划，实现了一流的卫生保健，卫生成果斐然可观，而费用则低于世界上任何其它高收入国家。This achievement was firmly anchored in a value system that places a premium on fairness and inclusiveness as a route to social cohesion, stability, and harmony.此一成就是坚实地奠定在这样一种价值体系上，即把公正和包容性视为社会凝聚、稳定与和谐之源。Research guided individual strategies, but so did the wishes of the public, with opinion polls undertaken and conversations started to ensure that changes in the health system won public support and approval.研究工作引导具体战略，但公众的意愿也起到引导作用，民意调查和对话确保了卫生系统的变革赢得公众的支持和赞同。As we have just heard, Singapores version of universal health coverage balances the advantages of competitiveness and other market forces with the need for state intervention to steer these forces in the right direction. It balances freedom to choose providers, services, and facilities with an obligatory health savings account, the MediSave plan, with its emphasis on individual responsibility.正如我们刚刚听到的，新加坡的全民健康覆盖模式，平衡了竞争和其它市场力量与需要国家干预来引导这些力量保持正确方向二者之间的好处。它对选择供应商、服务和设施的自由与强制性健康储蓄账户，即医疗储蓄计划作了平衡，后者强调了个人的责任。 There is no free lunch. The plan works to protect against the over-consumption of care. To help inform responsible decisions, the Ministry of Health publishes hospital bills for common illnesses on its website.世上没有免费的午餐。该计划有效地防止了医疗的过度消费。为帮助形成负责任的决定，卫生部在其网站上公布了一般疾病的医院账单。Another innovation, MediShield Life, embodies the principle of collective responsibility through risk pooling. This is the safety net. It protects households from falling into financial ruin when medical bills are especially high. Studies conducted by WHO show that catastrophic medical bills force 100 to 150 million people below the poverty line every year. While many governments are working hard to lift people out of poverty, these efforts can be offset when the health system and its financing actually contribute to poverty.另一项创新，即终身健康保险，通过风险共担，体现了集体责任的原则。这是一个安全网络。它保护家庭在医疗花费太高的情况下免于倾家荡产。世卫组织的研究表明，每年有 1 亿到 1.5 亿人因灾难性的医疗费用跌至贫困线以下。许多政府正在大力帮助民众脱贫，如果卫生系统及其收费实际上是在加剧贫困，则这些努力都将落空。As Singapores Minister of Health observed earlier this year, the scheme tells people that they “need not face lifes uncertainties alone, especially those who meet unexpected shocks in their life journeys.”正如新加坡卫生部长今年早些时候所言，该项计划告诉民众，他们“尤其是那些在生命旅途中遭遇意外变故的人，不会独自面对生活中的不稳定性。”Of course, not all of these innovations can be applied elsewhere. UHC is intrinsically country-owned. To work well, it must be home grown in line with each countrys culture, domestic political institutions, the legacy of the existing health system, and the expectations of citizens. 当然，所有这些创新，并非在任何地方都适用。全民健康覆盖本质上是国家所有。要想行之有效，它必须根据每个国家的文化、国内政治体制、现行卫生系统的遗产和公民的期望因地制宜。In achieving UHC, Singapore had some distinct advantages. The huge challenge of extending health services to reach remote and impoverished rural areas was non-existent. Singapore has only one rural area, a small island and tourist attraction.在实现全民健康覆盖方面，新加坡有一些独特的优势。不存在需要将卫生服务扩展到边远和贫穷农村地区的挑战。新加坡只有一处农村，是一个小岛和旅游胜地。A tradition of cross-ministry collaboration makes it easier to address the upstream causes of ill health through environmental improvements and the use of fiscal and regulatory measures to encourage healthy lifestyles.跨部门合作的传统使之可以通过环境改善和采取财政和监管措施来鼓励健康的生活方式，从而解决健康不良的上游原因。Singapore has also enjoyed political stability and a high level of public trust in government for decades. That helped as well.几十年来，新加坡还保持了政治稳定，政府的公信力极高。这也是很有帮助的。With these advantages, UHC in Singapore has gone beyond providing and financing fair and inclusive health care. UHC in Singapore has worked as a strategy for building an inclusive, caring, and progressive society. These are assets for any country in the world. 出于这些优势，全民健康覆盖在新加坡不仅仅是提供公平和包容性的卫生保健，并为之筹资。新加坡的全民健康覆盖成为建设一个包容、关爱和进步社会