Keeping up with specialist bills and why beauty therapy is more than skin deep

ABC 听吧。

ABC Listen.

播客、广播、新闻、音乐，还有更多内容。

Podcasts, radio, news, music, and more.

为什么人类总爱保留这些东西？

Why do humans hold on to stuff?

一些根本用不着，却又舍不得扔掉的小玩意儿。

Oddments we don't use and yet can't quite throw out.

这不只是你我这样。

It's not just you and me.

澳大利亚最古老的图书馆里，塞满了不是书的杂物。

Australia's oldest library is crammed with stuff that isn't books.

糟糕的画作、老旧的票根、人的头发。

Terrible paintings, old venues, human hair.

这到底是历史收藏，还是囤积成癖？

Is this history or hoarding?

我是安妮贝尔·克雷布。

I'm Annabelle Crabbe.

来翻一翻这些物件背后关于我们自己的故事吧。

Come and have a rummage through the story of us told by our stuff.

在ABC Listen或者你常用的播客平台搜索《历史还是囤积》这个节目。

Search for the history or hoarding podcast on ABC Listen or wherever you get your podcasts.

你好。

Hi.

我是泰根·泰勒，欢迎收听《生活万象》，这里由你的故事推动全国对话。

I'm Tegan Taylor, this is Life Matters, where your stories shape the national conversation.

你上一次跟不太熟的人吐露内心秘密，是什么时候？

When was the last time you told a casual acquaintance one of your deepest secrets?

会不会正好是你上次剪头发的时候？

Was it maybe around the time of your last haircut?

在理发店，当有人轻轻抚着你的头，你知道自己说的这些话根本不会传到当事人耳中，那些藏在心底的事，就不知不觉说出来了。

When you're in a salon and someone is caressing your head and you know what you tell them is never gonna make it back to the person you're talking about, the personal stuff just starts flowing out.

那理发师怎么处理这么多客户倾倒给他们的感情垃圾呢？

But what's your hairdresser to do with all the emotional muck their many clients leave sticking to them?

他们是不是该接受一些心理咨询培训，而不只是学剪发和染发？

Should they get counseling training along with the lessons on cutting and coloring?

这些内容我们接下来二十分钟里会聊到。

That is in the next twenty minutes.

另外，如果你已婚，你们当初是怎么商量姓氏问题的？

Also ahead, if you're married, what kind of conversations did you have about surnames?

是一个人改了姓，还是两个人互相改？

Did you did one of you take the others?

是合并了姓氏，还是干脆想了个新的？

Did you combine them or come up with something new?

我稍后会在ABC国家广播电台详细聊聊这个话题。

I'll get into it soon here on ABC Radio National.

不过首先，周二晚公布的预算把公平性和生活成本放到了核心位置。

But first, Tuesday night's budget put fairness and cost of living front and center.

尽管许多澳大利亚人正在尽可能节省开支，但有很多人告诉ABC，他们正在逐渐放弃医疗服务。

And while lots of Australians are cutting back wherever they can, many of you have told the ABC one thing you're increasingly sacrificing is your health care.

我们收到了大量留言，人们因为负担不起费用，推迟做检查、取消预约，或者延后专科治疗。

We have received countless messages from people delaying scans, skipping appointments, or putting off specialist treatment simply because you can't afford it.

这现在已成为卫生部长马克·巴特勒的重点关注事项，政府正在密切关注专科诊疗费用的上涨。

It's now become a major focus for the health minister Mark Butler, with the government looking closely at rising specialist fees.

多年来，这些费用持续攀升，每年几乎有一百万人因为价格太高而选择不去看专科医生。

For years, these fees have continued to climb to the point where almost one million people a year report avoiding seeing specialists because of the cost.

与此同时，非全科医生的专科医生仍然是全国收入最高的职业群体之一。

And at the same time, non GP specialists remain among the highest paid professionals in the country.

毫无疑问，专科医生对我们的医疗体系至关重要，但当医疗服务对这么多人来说都负担不起时，我们是不是该做更多来控制这些费用？

There's no question that specialists are essential to our health care system, but when health care becomes unaffordable for so many people, should we be doing more to rein in the fees?

今天早上，我很想听听你们的想法。

I would love to hear from you this morning.

如果你因为费用问题而推迟过任何医疗治疗，跟我讲讲你的经历。

If you've had to delay some kind of medical care because of the cost, tell me about it.

您的专科诊疗费用是不是已经高得吃不消了？

Are your specialist care costs becoming overwhelming?

今天和我们在一起的

Here with

是莫纳什大学卫生经济学中心主任安东尼·斯科特教授。

me is professor Anthony Scott, the director of the Centre for Health Economics at Monash University.

安东尼，欢迎来到《生活要事》。

Anthony, welcome to Life Matters.

早上好。

Good morning.

目前专科费用呈现出什么样的趋势？

What kind of trends are we seeing with specialist fees?

我觉得最近几年，如果您去看专科医生，而医生又不直接通过医保结算的话，每次就诊的费用平均每年上涨了大约11%。

Well, I think in the last few years, certainly, if you go to see a specialist for a consultation, the the fee for that, if they don't book bill you, has gone up by an average about of 11% per year.

如果拿这个数字和同期不到4%的通胀率相比，涨幅确实相当明显。

And if we compare that with, you know, inflation, you know, certainly below 4% in that period, then then then it's quite a rise.

今天和我在一起的还有加布里埃尔·凯利·戴维斯，她是澳大利亚疼痛协会的主席，患有慢性疼痛已经三十年了。

Also here with me is Gabrielle Kelly Davies, a Pain Australia advocacy group chair who's lived with chronic pain for thirty years.

加布里埃尔，这三十年来，你的经历是怎样的？

Gabriella, what has this looked like for you over the course of your illness?

费用一直在涨，越涨越高。

Well, fees are increasing and increasing.

就在本周，我去看专科医生，十分钟的问诊就花了六百澳元。

And just this week, my specialist cost $600 for a ten minute consultation.

我和我丈夫都做过手术。

And my husband and I have both needed surgery.

去年我们做了脊柱手术，每人自付的费用都超过了一万澳元，对我们这样的家庭和退休人士来说，根本负担不起。

And we had spinal surgery last year, and the out of pocket costs for each of us were over $10,000, which is totally unaffordable, for families and retirees like us.

但公立医院的排队时间太长了，遇到紧急或严重的病情，根本等不起。

But hospital waiting lists are so long the public system isn't a viable option for urgent or serious medical issues.

所以我们这些自费退休的人，只能动用养老金，但这根本不是长久之计。

So we've just had as self funded retirees, we've just had to dip into our super, which isn't a viable solution.

诺亚，你说你患有偏头痛已经三十多年了。

Noah, and you say you've had it's migraine that you live with for more than thirty years.

在这三十年里，费用发生了怎样的变化？

How have the fees changed over those three decades?

哦，涨得厉害。

Oh, they've skyrocketed.

涨得简直离谱。

Absolutely skyrocketed.

我现在去就诊，有时候就五分钟，收费就得三四十澳元。

So I'm finding, you know, when we go for or when I go for an appointment, it can just last for five minutes, and you're looking at 3 to $400.

这对普通家庭和退休人士来说，根本负担不起。

So it's just not affordable for the average family and for people who are retired.

正如我所说，公立医院系统也不现实，因为排队时间太长，加上人口老龄化，专科医生又严重不足。

And as I said, the public system's not viable because of the long waiting lists and aging population and the lack of specialists within the public hospital system.

安东尼，一次十分钟的诊疗就要六百澳元，我自己的工作可没收这么高的费用。

Anthony, I mean, $600 for a ten minute consultation, I'm I'm not charging that for the work that I do.

我觉得这可能是极端情况，还是说这其实挺普遍的？

I I feel like that is that the extreme end of the scale, or is that is that kind of standard?

听好了。

Look.

有些医生确实收费很高，这事儿吧，他们自己说了算。

I mean, I think some doctors do charge a lot and very high fees, and, you know, it's up to them what they charge you.

他们可能有固定的收费标准，但要不要用医保全额报销，还是由他们决定。

You know, they they might have some kind of fees which are fixed, but it's up to them whether they bulk bill you or not, for example.

如果你在私立医院住院治疗，医生要不要用保险的‘零自付’政策收费，也全看他们自己。

And if you're in a private hospital, for in hospital treatment, it's up to the doctors as to whether they charge you using no gap cover with your insurance or not.

所以医生在收费上自由度很大，你到底要不要自掏腰包，完全由他们决定。

So doctors have a lot of discretion as to what to charge you and whether you will have any out of pocket cost at all.

这都是我们这套医疗体系造成的，制度这么设计，想管住费用真的很难。

And that's a function of just the system that we have, the way it's been set up, and it makes it hard to kind of control fees really.

这种状况对需要专科诊疗的澳大利亚人造成了什么影响？

What sort of impact do we have affecting Australians who need this specialist help?

你开头提到过，有些人根本不去看医生，错过就诊之类的。

Well, I think you mentioned at the beginning about people not not not going to care, skipping visits and things like that.

这方面的影响确实不小。

So there is a lot of impact there.

公立医院的排队时间很长，但你也得想想，我们到底愿不愿意让医疗资源的获取取决于你有没有钱，而不是你真正的医疗需求。

And, you know, public hospital waiting lists are long, but I'm sure, you know, it's important to think about whether we want to make access to care dependent on ability to pay or or your need for health care.

加布里埃尔，刚才你说的是加布里埃拉，抱歉。

Gabrielle, you've talked about the Gabriella, sorry.

你提到自己是自费养老，为了支付这些费用，你不得不动用养老金。

You've talked about the fact that you are a self funded retiree, that you've had to dip into your super to pay for these fees.

你手头的这笔钱是有限的。

That is a finite resource that you're working with there.

你对未来的医疗安排有什么想法？

How are you feeling about what the future of your care looks like?

我觉得我们只能继续掏钱看病了，毕竟我们在变老，而公立医院系统已经超负荷了。

Well, I think that we're just going to have to keep dipping into health care because we're aging, and public hospital system the public hospital system is overloaded.

这对政府来说也很棘手。

It's difficult for the government.

他们真的进退两难，因为医疗预算正因人口老龄化和治疗成本上升而不断膨胀。

They're really in a difficult place because the health budget is increasingly blowing out because of the aging population and the increased costs of treatment.

对我们来说，我们只能兼职工作。

So I think for us, we we work part time.

虽然退休了，但我们还是兼职赚钱，用这份收入来支付医疗费用和昂贵的药品。

Even though we're retired, we work part time, and that income pays for our medical care and for our medications, which are expensive as well.

您正在收听ABC国家广播电台的《生活要事》。

You're listening to Life Matters here on ABC Radio National.

我是特根·泰勒，正在与莫纳什大学卫生经济学中心的安东尼·斯科特教授以及来自疼痛澳大利亚的加布里埃拉·凯利·戴维斯对话，她患有偏头痛三十年，不仅头疼，钱包也疼。

I'm Tegan Taylor chatting with professor Anthony Scott from the center of of health economics at Monash University and Gabriela Kelly Davies from Pain Australia who has lived with migraine for thirty years and is really feeling it both in her head and her hip pocket.

我想知道，为了负担专科诊疗费用，你们有没有不得不做出过妥协？

I'd love to know from you if you've had to make concessions to be able to afford specialist appointments.

凯伦说，我去看过眼科医生。

Karen says I went to an ophthalmologist.

他们检查得很仔细，但要做白内障手术，开口就要五千美元。

They were very thorough, but they wanted to charge me about $5,000 to operate on my cataracts.

我没有私人医疗保险。

I don't have private health insurance.

幸运的是，医院已经把我列在他们的待治名单里了。

Thankfully, the hospital have put me on their books.

另外，私人医疗保险对心脏病的覆盖也很有限。

On another matter, private health insurance doesn't cover much when it comes to heart problems.

Steph说，她的妇科医生每分钟收费十美元。

Steph says my gyno charges $10 a minute.

我做临时工，时薪是32美元。

I make $32 an hour as casual wages.

半小时的就诊费就要三百多，还是去年的价格。

A half hour appointment costs me over $300, and that was last year.

去看全科医生自费的话，通常要五十美元。

Out of pocket at the GP is usually $50.

另外，从周一开始，我已经做了两位专科医生的检查，还有两次核磁共振、CT和骨扫描。

Another, since Monday, there have been two specialists, two MRIs, CT, and bone scan.

我靠积蓄还能撑得住，但想到那些拿到止痛药处方却只能干等着的人，我就替他们难受。

I could make it happen using savings, but I feel for other people who've been given a script for endone and told to wait.

安东尼，我们刚才听到加布里埃拉说，政府现在处境挺尴尬的。

Anthony, we heard Gabriella just say before that the government's in a sticky spot.

费用太高了。

It's expensive.

政府目前采取了哪些措施？在你看来，接下来还该做些什么？

What kind of action has the government taken, and and what do they need to follow-up with in your opinion?

我觉得到目前为止，他们没做多少实质性的事。

I I guess so far they haven't done very much.

目前最主要的就是那个‘我的费用查询’网站。

The main thing is the My Cost Finder website.

现在参议院委员会正在审议一项法案，旨在提高专科医生收费的透明度。

There's legislation now in the senate committee inquiry about specialist costs, which is trying to make doctors' fees and charges more transparent.

你可以登录这个网站，他们正努力让你能看到每位医生的具体收费情况。

So you can log on to the website, and they're trying to then you'd able to actually see the individual doctor and their fees and what they charge.

但你知道，这可能效果有限，因为医生在见到你之后，还是可以调整他们的诊疗方案。

But that you know, might not work very well because it doesn't really address the issue that the doctor can still kind of change what they do when they see you.

而且很多人根本用不上这个网站，他们没这个渠道。如果全科医生在转诊时就能直接看到这些信息，那对患者做决定会更有帮助。

And also many people wouldn't use that, they haven't got access to it, it would be much better if that was actually accessible by GPs at the point that they refer you so you can make a more informed choice.

他们现在做了这些，部长也在考虑限制收费。但我觉得，得仔细想想这会带来什么影响，办法有好几种，其实挺复杂的。

That's what they've done and now the minister is considering capping fees, but I think you know it's important to think about what the effects of that might be, there's different ways to do that, It's quite complicated.

比如说，如果设了个收费上限，那些原本收费低于上限的医生，可能会趁机把价格涨上去。

You know, for example, if you if you put a cap on a fee, a doctor who charges below that might decide to increase their fee.

患者自付费用的变化也很难预测，因为医生总能找到办法，在收费受限的情况下维持收入。

And the effects on out of pocket costs are unpredictable as well, as doctors often find a way to maintain their earnings when when fees are capped.

所以这些政策往往会产生意想不到的后果，我们目前还说不准会怎样。

So, you know, the the these these policies have kind can have unintended consequences, which we're not quite sure about.

今天我们还请到了澳大利亚医学协会主席丹妮尔·麦卡伦医生。

Also here with us is the president of the Australian Medical Association, doctor Danielle McMullen.

丹妮尔，欢迎来到《生活之道》。

Danielle, welcome to Life Matters.

早上好。

Good morning.

谢谢邀请我来。

Thanks for having me.

您从专科医生那里听到他们对经营成本的反馈是什么？

What are you hearing from specialists about the costs of running their businesses?

是的。

Yeah.

跟经营任何小企业差不多。

A bit like running any type of small business.

维持运营的成本，一直在上涨。

The the costs of doing so, just keeping the doors open, continue to rise.

工资在涨，房租和电费这些开销也在升，而且专科诊所通常还配备着许多昂贵的设备，既要购买又要维护，保险费用也相当高。

Wages go up, the overheads of rent and electricity, and often specialist medical practices also have quite a lot of high cost equipment that needs purchase and maintenance alongside pretty hefty insurance bills.

所有这些成本都在持续上涨，而且医疗领域的通胀速度远高于整体通胀，这些因素共同推高了维持诊所运转的开销。

So all of that continues to rise at a rate health inflation rises much steeper than general inflation, but all of those continue contribute to the cost of keeping those doors open and running a practice.

我不需要你精确列出数字，但当我们听说一次十分钟的诊疗要收六百块，或者有人拿妇科医生的收费和他们的时薪做对比时，感觉简直像活在两个不同的世界。

I love to sort of you don't have to break down the numbers exactly, but when we're hearing someone getting charged $600 for a ten minute appointment or the text before that sort of compared what their gynecologist charges compared to what they earn per hour, they feel like they're in different universes.

你能帮我们理清一下，去看专科医生时，我们到底在为哪些服务付费吗？

Can you just help us understand a bit about what you're paying for when you're going to see a specialist?

是的。

Yeah.

我觉得这个问题问得特别好，因为有时候你确实会觉得，自己付的钱只是在为那个跟你面对面说话的医生买单。

I think that's a really great question because it is it does sometimes feel like you're paying for that one person who you're talking to.

但实际上，背后往往有一整个团队在支撑，包括前台、临床助理、护士、技术人员，他们的工资通常都来自同一笔诊疗费。

Often, there's a whole team there, number of receptionists, clinical assistants, nurses, technicians that who are often funded through that same fee.

所以你付的这笔钱，其实涵盖了多人的薪资，还有维持诊所运转的基础设施成本——比如电费、房租，以及各种设备的维护，这样才能完成床边超声检查或诊室内的治疗操作。

So you may be paying for multiple people's wages as well as the infrastructure, keeping the doors open and the lights on and the equipment running for them to be able to do that bedside scan or relative you know, in office treatments.

另外还有一点值得考虑：回顾过去十年、二十年，专科医生的收费总体上是跟工资价格指数同步上涨的。

And the other part I think it's worth looking at is over time, if we look back over the past ten, twenty years, specialist fees have largely increased in line with something called the wage price index.

这是一个衡量全国工资水平的指数。

So an index that looks at, you know, the wages across the country.

但医疗保险的报销额度却没跟上。

But what hasn't kept pace is that Medicare rebate.

政府对诊疗费用的补贴确实在增加，专科医生的收费也跟上了工资涨幅，但医保的这部分补贴却远远落后了。

And it's so the government's contribution to the fees out of pocket costs are certainly going up, and specialist fees have increased in line with wages, but that Medicare contribution to it has really lagged behind.

因此，患者自己掏的钱越来越多，钱包明显吃紧。

And so patients are paying more and feeling it in their hip pockets.

格拉坦研究所发布过一份报告，指出自2010年以来，专科诊疗费上涨了73%。

I mean, there was a report from the Grattan Institute that flagged that specialist fees have increased by 73% since 2010.

这可不像通货膨胀率的水平。

That doesn't sound like CPI.

这要看具体情况。

So it depends.

对。

Yeah.

你可以用好几种方式来算这些数据。

You then you you can run the numbers a bunch of different ways.

我们的模型显示，回顾过去十五到二十年，专科医生费用的增长幅度总体上跟工资和物价指数基本同步。

Our modeling does show that if, you know, if we look back over the past fifteen to twenty years, the the rate of specialist fee increases is largely in line with wage price index.

不过在过程中也有一些波动，这还取决于你是看自付费用，还是看整体费用。

And there have been a few fits and starts over the way in terms it also looks at whether you're measuring out of pocket costs or the fees in general.

当然，我们并不否认患者承担的费用确实在上涨，但关键是要全面看待所有推高费用的因素——就像加布里埃拉说的，现在公立医疗系统几乎排不上号，这迫使越来越多的人转向私立医疗。

So fees but there's no argument from us that fees costs to patients are going up, But it's really important that we have a broad look at all of the contributors to that, how much you know, how available, as Gabriela said, the public hospital system, it's now near impossible to get a public appointment, and that's then putting pushing people into a private sector.

医保报销跟不上，私人医疗保险也是，人们交的保费越来越多，但能拿回来的医疗福利却越来越少。

We've got MBS, you know, Medicare rebates lagging behind, and private health insurance, again, where people are paying more and more in premiums and getting less back in terms of medical benefits.

要真正解决自付费用高涨的问题，我们还得考虑医生收费之外的多种因素。

There are a range of considerations in addition to what doctors are charging that we need to take into account to really solve this problem of of out of pocket costs.

这是ABC国家广播电台的《生命关怀》节目。

It's Life Matters on ABC Radio National.

我是特根·泰勒。

I'm Tegan Taylor.

您现在听到的是澳大利亚医学协会主席丹妮尔·麦克穆伦医生的声音。

The voice you're hearing is that of doctor Danielle McMullen, who's the president of the Australian Medical Association.

我还请到了莫纳什大学卫生经济学中心的安东尼·斯科特教授，以及疼痛澳大利亚的加布里埃拉·凯利·戴维斯，这是一个倡导组织。

I've also got professor Anthony Scott here from the center of health economics at Monash University and Gabriella Kelly Davies from Pain Australia, is an advocacy group.

今天我们讨论的是专科医生的收费问题。

We're talking about specialist fees this morning.

这些费用涨得实在太高了。

They've risen so much.

你们在跟我分享自己的经历。

You're telling me your stories.

我收到的短信故事多到让我应接不暇。

I am overwhelmed with the number of stories that you're telling me on the text line.

有人留言说，是的。

One says, oh, yes.

我是跨性别者。

I'm trans.

跨性别者接受的医疗照护绝大多数都是自费的。

The vast majority of trans health care is private.

公立医生非常少，排队等候的时间甚至可能超过十年。

There are very few public doctors, and the waiting lists for those can be over a decade.

到目前为止，我在诊疗和手术上已经花了大约三万美元。

So far, I've spent about $30,000 on consults and surgeries.

有位叫Speno的人说。

Speno, that person says.

Ilya问，我能把心理医生也算进去吗？

Ilya says, can I throw psychologists in as well?

我女儿每周五十分钟的咨询费用，比她在合租房里的房租还高。

My daughter's weekly fifty minute appointment is more than her weekly rent in a share house.

医疗费用怎么就和生活成本脱节到这种地步了？

How has the health cost got so out of whack with living?

Chris说，我把专科医生的收费当作普通消费来看待。

Chris says, I treat specialists the same as any other transaction.

我问他们能不能帮我降低费用，或者是否能通过公共医疗系统做手术。

I ask what they can do to reduce my costs or if they're able to perform surgery through the public system.

我说明我没有私人医疗保险，也负担不起这么高的费用。

I explain I don't have private health insurance and that I cannot afford exorbitant fees.

克里斯说，如果你知道他们愿意帮忙时能做多少，你一定会惊讶。

Chris says you'd be surprised how much they can help if they want to.

安东尼，我们之前提过封顶收费这个想法，以及它带来的问题。

Well, Anthony, we've you mentioned before the idea of capping fees and the downfall there.

除此之外，我们还能采取哪些其他措施？

What other potential levers do we have to pull here?

我觉得政府也在考虑立法改革，比如修改规则——但要真正设定收费上限，就得直接规定具体金额，这可能会触碰到宪法中关于医生强制服务的条款，不过这部分解释一直比较灵活，所以他们完全有可能挑战并争取到设定专科医生费用和上限的权力。

Look, I think the government's considering legislative change as well, changing the rules and, you know, to to actually cap fees means setting fees, and that could represent a challenge to the kind of constitution where there's some words in there about civil conscription of doctors, but that's been interpreted quite differently, so they could challenge that and that would give them the ability to actually set specialist fees and set caps for those fees.

另一个办法是，如果医生收费超过某个标准，就不给予医保报销，但这样也可能导致患者自付费用反而更高。

Another option is to say that well if doctors charge above a certain amount then the Medicare rebate isn't paid, but again that might have adverse effects on out of pocket cost for patients.

总的来说，如果目标是减轻患者的自付负担——这和压低医生收费还不太一样——那政府就得花钱，要么扩大公立医院门诊，要么提高医保报销比例。

So I think as well, know, in general, I think if if the objective is to reduce out of pocket cost for patients, which is slightly different to reducing doctor's fees, then I think it will cost the government some money to do that either by expanding public hospital clinics or increasing Medicare rebates.

这也是一个可行的方案。

That's another option as well.

所以，这些措施可能需要搭配使用，但我们得小心别让政府出台政策时出现意料之外的副作用。

So you know, some combination of those may work, but we've just gotta be wary of unintended consequences in the government.

就像今年早些时候全科医生的全额报销激励措施那样，针对专科医生，如果真想达到这个目标，政府也得花钱。

As we've seen for GPs when they increased all the all the bulk billing incentives earlier this year, for specialists, it will cost some money as well, think, if that's our objective.

丹妮尔，参议院已经成立了一个委员会，专门调查专科医疗服务的可及性和可负担性。

Danielle, there's a senate committee established to investigate access to and affordability of specialists.

澳大利亚医学会的建议会包含哪些内容？

What will the AMA's submission be entailing?

我们还在仔细研究具体细节。

So we're obviously still, you know, considering the details of that.

但总的来说，我们会支持像安东尼刚才说的那样，全面审视那些推高患者自付费用的因素，并探讨如何解决这些问题。

But broadly, it will be encouraging a look at, as Anthony just said, that broad range of factors that contribute to out of pocket costs for patients and what we can do to address those.

比如提高费用透明度，确保患者在缴费前就清楚自己可能要付多少钱；调整医保报销比例，让政府的补贴真正落到寻求医疗服务的澳洲民众手里；同时加强公共医疗供给，让医疗体系里真正有多种选择。毕竟，正是公共与私人医疗之间的平衡，才让澳大利亚的医疗体系如此出色、独特，甚至在治疗效果上位居世界前列。但这两方面我们都得保护好。

Things like improving transparency and informed financial consent so people understand what fees they may be facing before they're stuck at the front desk, addressing Medicare rebates and making sure that government has a fair rebate back in the pockets of Australians seeking health care, and boosting that public provision so that there really are options in our health care system, because it is that balance of public and private care that makes Australia's health care system so wonderful and unique and world leading, in fact, in terms of our outcomes, but we need to protect both sides of that.

你的短信我这边都能收到。

Your texts are coming through to me.

巴里说，他养老津贴上唯一的奢侈开销就是私人医疗保险。

Barry says, my one extravagance on my aged care pension is my private health insurance.

2008年我等了两年才做上髋关节置换手术，这才逼得我买了保险。

I was driven to take it on following a two year wait for a hip replacement in 2008.

从那以后我一直留着它，虽然平时根本用不上。

I've maintained it ever since even though I make few calls on it.

这次费用下调，很可能会让我被迫退出私人保险，重新回到不堪重负的公立系统。

This latest reduction may well push me off private back into an overstressed public system.

还有人说，做一次心电图和超声检查，他多花了750块，要是去本地影像中心，根本不用这么多。

Another says they had three sorry, $750 more than they would have if they'd gone to a local scanning center for an ECG ultrasound for my heart.

我听从了专家的建议，选择在专科中心做这项检查。

I decided to have it at the specialist center room on their advice.

还有人提到，他做室内运动时不小心摔了一跤。

Another said, I had a fall while doing some indoor sports.

我实在负担不起给双肩都做核磁共振，看看为什么抬不起胳膊。

I could not afford to do an MRI on both shoulders to see why I can't lift my arms.

我只好先给症状更重的那一个肩膀做核磁共振。

I decided to just do an MRI on the shoulder that's worst affected.

所以现在我只治疗这一边的手臂。

As such, I'm only getting treatment in that one arm.

我今年五十五岁。

I'm 55.

我需要做手术，把肩膀上完全撕裂的肌肉重新接上。

I need surgery to reattach a full tear for muscle in my shoulder.

安东尼，我们刚听了丹妮尔说澳大利亚的医疗系统是世界一流的。

Anthony, we just heard Danielle describe Australia's health system as as world leading.

当有人不得不因为付不起钱，而选择只治一个肩膀的时候，我们还能这么说吗？

Can we still say that when we have stories like someone having to choose which shoulder they get treatment on because they can't afford both?

说实话，我们的医疗系统在国际排名上确实不错，但正因如此，我们容易变得自满。

Look, I think it it does the system does come up highly in the rankings of health care systems, but that I think leads to complacency on our part.

我们确实需要努力改善医疗体系的公平性，就像丹妮尔说的，让公共医疗体系承担更多责任，这样人们就不会再为自费项目发愁，医生们也能有更多选择去哪里工作。

We do need to try and improve you know equity in the system, as Danielle said, trying to shift the balance a bit more towards a public system so you know people don't face these out of pocket costs and doctors have more choice of where to work as well.

在公共系统里找工作很难，所以医生们只能去私人机构，这也就造成了我们现在这种局面。

It's hard to get a job in the in the public system, so they have to go in the private system, and so that, you know, leads leads leads to where we are now.

加布里埃拉，如果你自己来设计这个体系，你希望专科医生能提供什么样的服务？

Gabriela, what would you like to see from your specialists if if you were designing the system yourself?

我觉得这属于那种特别棘手的问题，根本没有简单的解决办法，因为专科医生并不处在竞争性的市场环境中，竞争本可以压低他们的收费。

Well, I really feel it's one of those wicked problems that doesn't have an easy solution because specialists aren't part of a competitive marketplace where competition helps to drive down their fees.

所以他们根本没有动力去降低费用。

So they don't have any incentive to reduce their fees.

如果政府设个费用上限，我敢肯定他们总有办法绕过去。

And if the government bought in a cap, I'm sure they'd find a way to get around that.

而且正如我们之前提到的，国家经济实在负担不起大幅提高医保报销比例了，因为医疗预算已经承受着巨大压力，而这压力主要来自人口老龄化。

And if as we've talked about, the national economy can't afford to increase Medicare rebates much because the health budget's already under such immense pressure, and and it's increasing so because of the aging population.

像《消费者选择》这类机构说的，当人们需要医疗，尤其是紧急治疗时，公立医院的排队时间太长，逼得他们只能转向私立系统，可退休人员、普通家庭，还有很多人根本负担不起。

And consumers like Choice, as we've talked about, if they need medical care, especially if it's urgent, public hospital waiting lists are so long, it forces them into the private system, which retirees and the average family and many, many people just can't afford.

我觉得这属于那种我们或许能想办法解决的问题，但本质上是个结构性、系统性难题，我真不觉得有什么简单办法能让所有人都满意，尤其是那些强大的医学团体。

So I think it's one of those problems that we can try and come up with solutions, but I can't I think it's a structural systemic problem, and I just don't know that there is an easy solution and that keeps everybody happy, particularly the powerful lobby group, the medical colleges.

他们是个非常强大的利益集团。

They're a very, very powerful lobby group.

安东尼，听起来目前有不少潜在的解决方案在被讨论。

Anthony, it sounds like there's a lot of potential solutions being considered.

但没有一个看起来是完美的。

None of them seem perfect.

如果我们什么都不做，会怎么样？

What happens if we do nothing?

那情况就会继续维持现状。

Well, things will continue as they are.

我觉得随着人口增长、人们对医疗的期望提高、技术进步，成本只会越来越高，特别是如果私有医疗体系占主导的话。

I think as population, people's expectations of healthcare increase, technology increases, know, that's gonna leading to increased costs particularly if you have more of a private system.

所以我认为政府必须做出选择：是推动长期的结构性改革，还是只做些短期调整，改改规则，可这些规则医生们总有办法绕开，最终也未必能达到政策目标。

So I think you know the government does have to decide what to do, are they going to choose some kind of long term structural reform or are they just going to stick to the short term and try and change some rules and regulations which you know doctors might get around and might not really achieve the policy objectives.

你知道，医疗保险的设计初衷是为了减轻患者的自付费用负担。

Know, health insurance system is designed to reduce out of pocket cost to patients.

医保已经为公立医院做到了这一点，对全科医生也做了一些覆盖，但专科医生这块还是最后没解决的环节。欧洲大多数国家都已经实现了，但这需要政府投入大量资金和资源。

We've Medicare did that for public hospitals, we've done it a little bit for GPs, specialists are the last kind of thing, and, you know, most of the countries in Europe have managed to do this, but it does take money and investment from government to make that happen.

安东尼、加布里埃拉、达尼埃尔，非常感谢你们今天早上分享的真知灼见。

Well, Anthony, Gabriela, Danielle, thank you all so much for sharing your insights this morning.

安东尼·斯科特教授是莫纳什大学卫生经济学中心主任。

Professor Anthony Scott is the director of the the Centre for Health Economics at Monash University.

加布里埃拉·凯利·戴维斯是澳大利亚疼痛协会倡导小组的主席，达尼埃尔·麦克穆伦医生是澳大利亚医学协会的主席。

Gabriela Kelly Davies is the chair of Pain Australia's Advocacy Group, and doctor Danielle McMullen is the president of the Australian Medical Association.

也谢谢你们提供的文字反馈。

Thank you as well for your texts.

你们之间花的钱可真是成千上万啊。

Lots and lots of thousands of dollars being spent among you.

如果你们发给我的信息属实，有一个人说，我这个月做了个专科医生转介的核磁共振检查。

If what you're texting me is to be believed, one says, I had a specialist referred MRI this month.

这次检查花了我675澳元，一分都报不了。

It cost me $675 with no rebate.

要是你唯一的收入就是养老金，这压力实在太大了。

Very hard when your only income is the pension.

还有人说，问题在于得反复跑专科医生那儿：先得拿检查的转诊单，光是影像检查就得自付500澳元，然后还得再跑一趟让医生解读结果，接着可能还得再去一次。

Another says, the problem is the number of visits to and from the specialists to firstly obtain a referral for a test, a radiology scan, which is in turn can be $500 out of pocket, then back to have it interpreted, then back to have another one.

还没反应过来，你已经跑了五趟，花了上千澳元，结果就为了弄清楚自己到底哪儿有问题。

Before you know it, you've done five visits all over the shop for thousands of dollars just to be told what's going on.

还有人说，我现在看全科医生的自付部分，已经比医保补贴还高了。

Another says my GP gap fee is now greater than the Medicare rebate.

总费用98澳元，自付部分大约55澳元。

Total fee, $98, about $55 gap.

十八个月前，看风湿科的自付费用还是250澳元。

Rheumatologist gap eighteen months ago, $250.

后来我就干脆不再定期做半年一次的复查了。

I stopped going to routine six month checkups.

不过别走开，接下来在ABC国家广播电台的《生活之道》节目中，我要说一些我告诉理发师、但希望她带到坟墓里去的秘密。

Well, stick around because on Life Matters here on ABC Radio National next, there are things I've told my hairdresser that I hope she takes to her grave.

要不我先搜一下，病人隐私权是不是也适用于美容行业？

In fact, let me just Google if patient confidentiality extends to the beauty professions.

我查到了再告诉你结果。

I'll let you know how I go.

如果算算我这些年在理发店和美容院花掉的时间，说实话，光是想想这个数字都让我有点发怵，但总之，时间多得惊人。

If I tally up the number of hours I've spent in hairdressers and beauty salons over the years Actually, the idea of putting a number on just how much time I've spent there is a bit scary, but suffice to say, it's a lot.

我们当然可以说，社会对女性外表总有某种标准，总在引导我们花更多钱在这上面。

And we could talk about how women are generally held to a certain standard when it comes to how we look or how society funnels us towards spending more money on it.

但我得说，我其实挺享受在美容院的时光。

But I've got to say, I kind of love a salon moment.

对我来说，那是一个小时甚至更久的时光，可能翻翻杂志，但更多时候是跟一个耐心倾听的人聊聊天，或者更准确地说，是找一个不得不听我说话的听众。

It's an hour or so or more for me to flip through a magazine, maybe, but mostly to have a yak to a caring listening ear or sometimes maybe more accurately, a captive audience.

我跟理发师说的也不是什么惊天动地的秘密，不过我倒是听过其他顾客在店里聊的那些话。

I'm not telling my hairdresser anything too juicy, but I've overheard things from other people in the salon.

有时候，话题会突然变得特别沉重。

It can get really heavy kind of out of nowhere.

等到一天结束，剪刀、洗发水和吹风机都收起来了，美容师们却还得独自扛下我们所有的烦恼，可他们从来没接受过这方面的培训。

And when the scissors and the shampoo and the blow dryers are packed away at the end of the day, those salon workers are left holding all our messy baggage with no training on what to do with it.

最近有项新研究指出，像美容师、理发师、美甲师这些实际上承担了心理倾诉角色的人，需要更多支持和工具，来应对我们向他们吐露的心事——稍后我会详细说说。

There's been new research that's outlined the need to better equip the people who become our de facto therapists, the beauticians, hairdressers, nail techs, to give them the tools to respond to what we tell them, which I'm about to give you a bit more detail on in just a tick.

不过，我也想趁这个机会，鼓励大家今天给自己的理发师或美容师点个赞。

But I also want to give you the chance to give your hairdresser or barber a shout out today.

有没有哪位美容从业者，在你最难熬的时候帮过你？

Who is the beauty professional who really helped you through a rough patch?

是什么样的特质，让你在他们面前能毫无顾忌地倾诉？

What is it about that barber or hairdresser that makes you feel comfortable enough to potentially overshare a little bit?

今天和我一起的是斯泰西·佩奇，她曾是理发师，现在是一名心理学研究者。

With me here is Stacy Page, a former hairdresser, now psychology researcher.

斯泰西，欢迎来到《生命的意义》。

Stacy, welcome to Life Matters.

早上好。

Good morning.

所以理发是你第一份工作。

So hairdressing was your very first career.

你开始干这行的时候多大？

How old were you when you started out?

我14岁的时候开始当学徒。

I was 14 when I started my apprenticeship.

明白了。

Okay.

这年纪可真小啊。

So this is young.

你那时候都接受什么样的培训？

What kind of training were you getting at that age?

一般来说，当学徒的话，每周去一次技校，其余时间都在店里实际操作。

So generally, when you're an apprentice, you go to trade school for once a week, and then the rest is on job on the job training.

所以我平时是直接服务客户的。

So I work with clients.

他们并不会。

They don't Yeah.

接着说。

Keep going.

不好意思。

Sorry.

对。

Yeah.

没人教我们该怎么跟客户沟通。

They don't train us on how to communicate with our clients.

完全是自己硬着头皮上，然后别人会把各种秘密都告诉你。

It's you kind of thrown in the deep end, and people will tell you everything, secrets of all sorts.

这些事是从你刚入行就开始的，还是说等你年纪大一点，别人才开始跟你分享这么私密的事情？

Was this, like, from the get go, or was it when you got a bit older that people started sharing very personal stuff with you?

随着我年纪增长，因为有了自己的客户， conversations 也变得更深入了。

As you get as I got older, it was sort of more in-depth because I had my own clients.

刚开始当学徒的时候，你基本上就是个洗头的，给客人洗头发的时候，很多话都会在洗头台那儿说出来。

At the beginning, when you when you start your apprenticeship, you're kind of the shampoo girl, so you you're washing people's hair and a lot can come out at the shampoo station.

都是一些什么事呢？

What kind of things?

我觉得，因为你接触了别人，他们就会觉得可以碰你，或者跟你聊私密的事。那种身体接触让界限变得模糊了。

I think because you're touching someone, it almost makes them feel like they can either touch you or talk to you about private things because they I kinda feel like the boundaries of, you know, are kind of murky because of that physical contact.

所以在洗头台那儿，有些人会把这当成一种性暗示，跟你开些露骨的玩笑；也有人压力太大，突然就开口说，‘我老公今天又打我了’之类的话。

So, you know, at the shampoo bowl, some people take it as like a sexual advance or most and they'll make, you know, sexual comments to you about it or, you know, someone might be very stressed and then all of a sudden open up and talk about, oh, my husband was really violent with me today or something like that.

这些话就这么自然而然地冒出来了。

It just kind of comes out.

他们几乎忘了自己是在跟一个年轻人说话，不管对方是谁。

They almost just sort of forget that they're talking to a young person or whoever it is.

他们就是忍不住把心里的事全倒出来。

They just open up and spill what's on their mind.

你当时还是个 teenager，遇到这些事一定特别难应付吧。

That must have been so confronting as a as a teenager for you.

确实如此。

It really was.

是的。

Yeah.

有客户告诉我他们的孩子刚去世，我听了当场就哭了出来，根本不知道该怎么应对这样的消息。

So, you know, I had clients tell me that their children had just died, and I'd burst into tears not being able to sort of cope with that information.

曾经有位客户进来告诉我，医生刚跟她说要准备后事了。

So I had someone come in and tell me that the doctor just told them to get their affairs in order.

我当时根本不懂那句话是什么意思。

And I didn't know what that meant.

所以我脱口而出：‘哦，那挺好啊。’

So I said, Oh, that's nice.

有条理是好事。

It's good to be organized.

直到他们走后，我老板才过来问我：你知道他们刚跟你说的是什么意思吗？

And it wasn't until they left that my boss came up to me and said, Do you have any idea what they just said to you?

你当时处理得不太妥当。

You didn't handle that very well.

我感到特别自责。

And I felt terrible.

那是十五年前、二十年前的事了，可我一直记到现在。

And that was fifteen, twenty years ago, and I still have held that with me.

是的。

Yeah.

我能想象那种事

I can imagine that's the sort of thing

会在凌晨两点还在你脑子里反复回放，Stacy。

that plays over in your head at 02:00 in the morning, Stacy.

我就在想，你老板过来告诉你那样做不合适，但听上去你当时根本没人教你怎么应对这种状况。

I'm just thinking about your boss coming up and telling you that that was inappropriate, but it doesn't sound like you ever had any kind of training or or guidance on how to deal with a situation like that.

一点都没有。

None at all.

根本没人让你事后跟同事聊聊，说有人刚对我说了那种话，我实在受不了。

You know, there's no options to kind of debrief even with the start with a staff member after and say someone's just told me this and I'm feeling overwhelmed.

你就像被直接扔进TAFE一样，没人管你。

You know, you just sort of thrown in like we're in TAFE.

他们只教你技术活，从不教你怎么跟客户打交道。

They teach you how to do the technical side of things that they don't sort of tell you about how to interact with clients.

他们只告诉你别谈性、政治和宗教。

They tell you not to talk about sex, politics, or religion.

但要是客户自己提了，你就只能顺着他说。

But if a client brings it up to you, you kind of you you just have to go with what the client says.

客户永远是对的，这是规矩。

You're told the client's always right.

所以你只能跟着他们的思路走。

So, you know, you just have to lean into what they're talking about.

所以，Stacy，我们今天找你聊天，一部分原因是你的美发背景，但更重要的是，你共同撰写了这项关于这个话题的新研究，待会儿我们会详细聊聊。

So, Stacy, part of the reason we're chatting to you today is because of your background in hairdressing, but a big part is because you've co authored this new research into it, which we'll get into in a moment.

但我很好奇，这种情感上的负担在多大程度上影响了你离开这个行业的原因。

But I'm wondering how much this emotional toll fed into your decision to leave the profession.

这确实是一个非常重要的原因。

It fed a lot into it.

我只是不太理解人们。

I just I didn't understand people.

所以我去读了心理学学位，就是想弄清楚该怎么更好地与人相处。

That's why I went to do a psychology degree because I just wanted to understand how to interact with people better.

是的，确实如此。

It's yeah.

我后来意识到自己已经精疲力尽了，但根本不知道为什么。

I realized that I was burnt out and I didn't understand why.

当我开始把研究聚焦在这个领域时，一切就都豁然开朗了。

And when I started to focus my research on that area, it all made sense.

很多人离开这个行业，是因为他们不知道该怎么应对。

And a lot of people are leaving the industry because they don't know how to cope.

他们都很年轻。

They're very young.

在TAFE读书的时候，年龄一般在15到18岁之间。

When you're at TAFE, you're between the ages of 15 and 18.

人生阅历太少，连怎么进行这类对话都不懂，更别说有系统的课程教你怎么回应，既能保护自己，也能照顾到客户。

And there's not a lot of life experience to kind of guide you in even how to have those kind of conversations, let alone a proper course that teaches you how to respond in a way that protects both you and the client.

这里是ABC国家广播电台的《生命的意义》。

To Life Matters here on ABC Radio National.

我是特根·泰勒，正在和斯泰西·佩奇聊天。

I'm Tegan Taylor chatting with Stacy Page.

她14岁就开始当理发师，现在是阿德莱德大学的博士候选人，正在研究美发行业中的情绪劳动带来的影响。

She started out as a hairdresser at age 14, is now a PhD candidate at the Adelaide University doing a study into the impact of emotional labour on salon workers.

接下来你会听到更多关于这项研究的内容，但我也很想听听你的看法：如果你去过美发店，或者你本身就是美发师、理发师、美甲师，有没有遇到过别人对你敞开心扉的情况？他们都跟你说过什么？你又是怎么应对的？

You're about to hear a little bit more about that study, but I'd also love to hear from you about what you think it might be that causes you to open up a bit if you're at the salon, if this is something you've done before, or if you are a salon worker, a barber, a hairdresser, a nail technician, what kind of things have people told you, and how have you dealt with that?

有个人说，我上次剪头发时，理发师边给我剪边哭，说她刚和男朋友分手，这简直反向心理咨询。

One person says, my hairdresser sobbed during my last cut as she told me about her recent break up with her boyfriend, reverse therapy.

还有人说，这建议真不错。

Another person asks us, this is good advice.

你千万别跟第三方吐露秘密，因为你说的那些事，万一被传出去，别人还是能猜出你指的是谁。

You should never share secrets with a third party because you may disclose facts which, if they were repeated, as an example, you could nevertheless identify the person of whom you speak.

说得对。

Yeah.

欢迎发短信到 0418226576。

Text me 0418226576.

你不用跟我讲你的私事，但我很好奇，你以前去理发店时，有没有想过要跟理发师说点什么？或者你要是做这一行的，有没有遇到过别人跟你倾诉的情况？

You don't have to tell me your secrets, but I'd love to know what kind of things you may have been tempted to tell at the hairdressers before or received if you are a hairdresser.

今天和我一起的还有汉娜·麦坎博士，她是斯泰西这篇新论文的合著者。

Well, also here with me is doctor Hannah McCann, Stacy's coauthor on this new paper.

汉娜在墨尔本大学工作。

Hannah's at the University of Melbourne.

Hannah，美容行业的从业者们是怎么描述这种现象的影响的？就是Stacy提到的，在理发椅上过度倾诉的现象。

Hannah, what kind of impact did the workers in the beauty beauty professions describe having from this phenomenon where what Stacy's talking about, this oversharing in the salon chair?

是的。

Yeah.

非常感谢邀请我来，也很高兴Stacy也在。

Thanks so much for having me, and it's so great to have Stacy here too.

你好，Stacy。

Hi, Stacy.

你好。

Hi.

嗨。

So hi.

其实，这么多年来，我们虽然在做各自独立的研究项目，但后来把它们整合在一起了，因为我们不断发现同样的情况。

I just, yes, I think the thing is that over the many years that we've been working on these actually separate projects, but we've brought our research together because we have you know, we're finding the same thing over and over.

生活中发生的一切，最终都会在理发椅上流露出来。

That everything that happens in life comes into the salon, is expressed in the chair.

这些可能是特别美好的事。

So that can be wonderful things.

比如婚姻幸福、感情升温、孩子出生，还有生活中那些温馨细腻的瞬间。

That can be, you know, marriages and relationship highs and birth of children and wonderful, lovely things, the texture of everyday life.

但与此同时，也包含了很多特别艰难的事。

But at the same time, it's also all of the really difficult things.

比如绝症。

It's terminal illness.

比如分手。

It's breakups.

比如出轨。

It's affairs.

我接触过不少美发师，他们往往是第一个得知客户流产消息的人，甚至比伴侣还要早知道。

I talked to multiple salon workers who were the first one to hear about someone's pregnancy loss before the intimate partner had even heard about the pregnancy loss.

所以他们要默默承担很多情感负担，然后马上又要切换到下一个客户。

And so really carrying a lot for people emotionally and then immediately having to switch between clients.