北大博雅特聘教授刘国恩：对全球疫情的反思

来源：北大国发院

背景介绍：新冠肺炎疫情的蔓延给世界各国人民的生命安全和身体健康带来严重威胁。病毒的肆虐需要中美两国合作面对，共同克服眼前的困难。在此背景下，美国美中关系全国委员会和北京大学国家发展研究院邀请中国和美国的顶级专家开启中美健康二轨对话特别公共活动，对公共健康改革、隔离政策与医疗卫生供给等方面的问题进行深入的探讨。

COVID-19 has brought unprecedented health threat to people around world． The rapid spread of COVID-19 calls for the cooperation between China and United States to tackle common threats． In this context， a virtual program with experts from China and U.S． was held by National Committee on United States-China Relations and the National School of Development at Peking University to discuss the topics of public health reforms， containment strategies， and healthcare delivery， and further reforms．

【嘉宾观点】

中国采取了全国上下严格的管控措施应对新冠疫情

首先，中国采取了全国上下严格的管控措施应对新冠疫情。在强大的中央政府指挥下，采取了封锁、检测、追踪和隔离阻断等一系列措施。更重要的是，各级地方政府紧跟这些措施，通过严密社区网络管理，在供应侧（企业）和需求侧（家庭）同时发力干预，得以实现几乎所有地方的全覆盖。

Under the command of our strong central government， a series of measures were implemented， such as lockdown， screening， tracing， and isolation． More importantly， these measures were closely followed by the local governments to implement， a nearly universal coverage of the state interventions through the highly regulated nationwide community networks on both supply side – for business， and demand side – for household．

不同国家文化的差异

其次，非政府因素对健康的结果也很重要。不同国家的人们在社交距离等自我行为防控上也有明显的差异，背后的主因之一来自于不同国家文化间的差异，比如个人对健康和财富之间的权衡、生命的长短和生活的质量取舍上的选择差异。国家间的文化差异带来行为上的差异，从而也影响抗疫的健康结果。比如，为了抗击疫情，中国和印度都推行了非常严格的政府管控，但是两国人们的自身防控行为很不相同，这对两国的不同健康结果有着重要的影响。另一个有趣的例子是中国和日本。中国的政府规定防控力度更加强大，日本则更多强调和依靠公民的自律行为，也在经济和健康两个方面取得突出成效。

The non-governmental conditions also play a vital role in the health outcomes． For instance， people from different cultures may behave differently on social distancing and self-protections． Trade-offs between health and wealth， or quantity and quality of life may contribute to different outcomes． For instance， both China and India take very strict state orders， but people between the two nations behave quite differently in risk protections against the virus． Consequently， the two nations had quite different health outcomes． Another interesting example is China and Japan． China is much stronger in government order， while Japanese government counts more on the role of good citizens’ self-compliant behaviors， also resulting in outstanding economic and health outcome so far．

公立医院的运用

第三，中国充分利用公立医院的优势来应对疫情。为了抗击病毒，政府在全国范围内动员了42000多名医务人员加入到湖北武汉抗击病毒的第一线，同时从全国卫生系统大量抽调医疗技术物资支援武汉等湖北省的感染城市。得益于这些保障条件，确诊患者应收尽收，几乎所有确诊病例都在公立医院得到治疗。

Public hospitals have been fully utilized to contain the pandemic in China． The government mobilizes more than 42000 healthcare professionals from nationwide to join the front-line Wuhan， Hubei to fight against the virus． A broad range of medical and technological supplies， most of which are from the public health system， are provided to support Wuhan and other areas in Hubei． As the result， almost all confirmed cases receive treatments in public hospitals．

关于中国疫情防控过程中的思考

首先，疫情防控的成本有效性。固然，所有COVID-19患者在大医院能够得到优质的治疗服务。一个有待探究的问题是，将所有患者集中医院救治是否具有经济学的成本有效？根据国内外的大量流病研究结论，新冠患者80%以上属于轻症，其中大多可在基层医疗机构和社区卫生服务中心得以很好的照料康复。假如新冠疫情以后每年成为人类的“常客”，并且发生规模涉及多个地区，那么在医院收治所有患者的医疗模式不仅可能存在可持续性问题，同时还会闲置大量基层医疗机构的人财物资源。

第二，在全国大幅倾斜配置医疗和财政资源集中应对COVID-19患者的同时，许多其他疾病的患者由于大多医院强行要求关闭或减少相关科室而不能获得及时治疗。从医疗资源配置效率和社会福利的综合考虑，我们应该在COVID-19造成的可见生命损失和其他主要死亡杀手的无形生命损失之间进行更科学、更理性的决策权衡。作为参考，根据2020年全球疾病负担上半年的数据可知，迄今为止，全球COVID-19的死亡人数平均每天约为3500人，而人类面临病死风险的“头号杀手”心血管疾病的日均致死率高达48000多人。

First， while almost all COVID-19 patients in Wuhan obtained good-quality treatments from hospitals， but a question remained is whether and how it is economically cost-effective to treat all patients in hospitals regardless of their conditions？ Epidemiological data finds that over 80% of the confirmed cases are in mild conditions， many of which may be better treated in community-based healthcare providers or even home care with an appropriate medical support． What if COVID-19 would be back for multiple times and would be at a much larger scale in many regions in the future？ Would it be sustainable to treat all patients in hospitals while idling many of the non-hospital facilities and resources？

Second， allocating almost all medical and financial resource nationwide to focus on treating the identified COVID-19 patients， many patients with other diseases such as cardiovascular or cancer conditions were put on hold without immediate treatment due to hospital shutdown or limited access to care． It is necessary to consider the trade-offs between visible lost lives immediately from COVID-19 and invisible lost lives from other leading killers． As a reference， the total death tolls of COVID-19 around the world were about 3500 per day for the first half year of 2020， while cardiovascular disease alone killed over 48000 people per day globally．

讨论

Discussions：

中美如何合作？

“How China and US can collaborate？”

美国是技术领先者，中国是追赶者，美国更为关注技术窃取和知识产权保护等问题，这在情理之中，也可以理解。但为了更好促进两国之间良好而有效的合作，美国如果能够制定出更为透明和易于遵循、执行的指南，这对两国和整个世界都会更有益处。两国研究人员因此可以通过访问计划、教育计划和其他举措继续进行交流学习。

US has been a technological leader， and China is still a follower in many fields． It is reasonable and understandable for US to concern more on technology stealing and intellectual property right protections． In order to promote a good and effective collaboration between US and China， I think it is good for US to come up with more transparent and easy-to-follow guidelines． Following such guidelines， researchers in both countries can continue to perform exchanges in science and technology through visiting scholar programs， educational programs and other initiatives．

关于指导方针

“About the Guideline”

我非常关注当前不利于中美两国以及全球合作的政治环境。但无论喜欢与否，我们的社会都由政府管理。因此，我再次呼吁两国政府见面、对话和商谈，能够形成更为透明、易于遵循和实施的行动指南。这样，我们就能向前迈进，更好推进全球合作。

I am very much concerned with the current political environments that are not instrumental to our collaborations globally． Whether like or not， we are all run by governments． I highly recommend that the two governments meet， talk， and discuss to come up with collaborative guidelines that are transparent and easy to follow and implement． With such good guidelines available， we can move ahead to better collaborate around the world．

（何庆红、姜又菲整理）

刘国恩，北大博雅特聘教授、教育部长江学者特聘教授、北大国发院教授，北大中国卫生经济研究中心主任。刘国恩教授研究领域为健康与发展经济学，国家医疗体制改革，以及医药经济学。

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