微保险Naya Jeevan：让更多巴基斯坦人病有所医

Pakistan, like many other developing countries, has a health-care system that is split between low-cost government-funded hospitals offering basic services and expensive private-sector medical institutions. But the majority of the country's 190 million people have little access to health care.

与许多其他发展中国家一样，巴基斯坦的医疗体系既包括负责提供基本医疗服务的低价公立医院，也包括昂贵的私人医疗机构。然而，在巴基斯坦的1.9亿人口中，大多数人都很少能享受到医疗保健服务。

To overcome the system's flaws, some local social entrepreneurs are coming up with new ideas to provide the poor with access to better medical services.

为了弥补巴基斯坦医疗卫生体系的缺陷，当地的一些富有社会责任感的企业家正在提出一些新的想法，目的是让穷人拥有获得更好医疗服务的机会。

Government-funded facilities cover less than a third of the country's population because there simply aren't enough of them and some of them don't have the resources to offer advanced medical treatment, according to Sania Nishtar, founder of Heartfile, a nonprofit think tank in Islamabad. Most people would have to pay varying amounts out of their pockets to access private-sector services that tend to be expensive and aren't always reliable. As a result, many poor people end up with no access to health care at all.

伊斯兰堡非盈利智库Heartfile的创始人尼什塔尔(Sania Nishtar)说，公立的医疗机构只能满足巴基斯坦不到三分之一人口的需求，原因很简单，医疗机构的数量不足，而且其中的一些医疗机构不具备提供先进医疗服务所需的资源。大多数人要获得私营医疗机构的服务需要自己支付数额不等的费用，这些私营医疗机构往往非常昂贵，而且有时并不可靠。结果就造成许多穷人最终根本无法得到医治。

One problem is that the country's health-care infrastructure is chronically underfunded, with only 0.8% of gross domestic product in 2010 allocated for public health, according to the World Bank. India spent 1.2%.

造成上述现象的一个原因是，巴基斯坦的医疗基础设施长期缺乏资金。根据世界银行(World Bank)的数据，2010年，对公共卫生领域的投资仅占巴基斯坦国内生产总值(GDP)的0.8%。印度的这一比例为1.2%。

Since the early 1990s, there have been repeated calls to allocate more tax revenue to the health-care system and to find alternate means of funding it, but without much success.

自上世纪90年代初以来，把更多税收收入分配到医疗保健体系、寻找其他渠道为医疗体系提供资金的呼声曾一再出现，但并未取得太多进展。

As long as a poor person can find a government-funded hospital, each patient by law will be eligible for a bed, a checkup and some basic medicine free of charge. But if, for instance, the patient requires a knee replacement or a heart valve and can't afford it, the state system requires that the person's application be first sent for approval to a separate office, a process that can take weeks for a sign-off on even urgently needed surgeries, according to Dr. Nishtar. Pakistani health officials couldn't be reached to comment.

根据巴基斯坦的法律，只要进了一所公立医院，每位病人就都能够有资格免费获得一张病床、一次体检，以及一些基本药物。但尼什塔尔说，假如一位病人需要膝关节置换手术或是心脏瓣膜却又无力承担，根据巴基斯坦的国家规定，这位病人首先需要将申请发送到一个另外的办公室进行审核，这一过程可能需要几周的时间，哪怕是非常紧急的手术。记者无法联系到巴基斯坦卫生系统的官员置评。

Given the absence of comprehensive public health-care services, a largely unregulated private sector, with hugely disparate services and prices, has sprung up to fill the void. But currently only 0.8% of Pakistan's GDP is allocated to insurance products, including health insurance, according to the country's insurance regulator. Poor patients often end up taking out loans and falling into debt to pay for private-sector services.

由于政府无法提供全面的公共卫生医疗服务，巴基斯坦出现了一个基本上不受监管的、旨在填补这一缺口的私营领域。这个领域的服务良莠不齐，也没有统一的价格标准。但是根据巴基斯坦保险监管机构提供的数据，目前仅有0.8%的GDP被用于支付包括医保在内的社会保险产品。为了获得私营领域的医疗服务，贫穷的病人通常不得不申请贷款并最终背上沉重的债务负担。

To address such needs, Asher Hasan set up Naya Jeevan─'new life' in Urdu─a nonprofit micro-insurance program for the urban poor.

为了应对这一状况，哈桑(Asher Hasan)建立了Naya Jeevan（乌尔都语“新生命的意思），这是一个针对城市中穷人的非盈利微保险项目。

'Everyone should have access to quality health care irrespective of their level of income,' said Dr. Hasan, who grew up between Karachi and the U.K. and then moved to the U.S. to study medicine.

哈桑博士说，无论收入水平如何，每个人都应该获得优质的医疗服务。哈桑在巴基斯坦的卡拉奇和英国长大，后来赴美学医。

Naya Jeevan, one of 12 finalists in The Wall Street Journal's Asian Innovation Awards, offers an insurance program at subsidized rates under a national group health-insurance model. It tied up with large multinational corporations and local companies to offer subsidized health-insurance plans for their low-income and contractual employees as well as the employees' domestic helpers, who are often poor.

Naya Jeevan是入围《华尔街日报》2012年亚洲创新奖最终决赛单元的12个项目之一，这是在国家的集体医保模式下以补贴价格提供的一种保险项目。该项目与大型跨国公司和本土企业合作，为其低收入员工和合同工，以及员工家里通常并不富裕的家政服务员提供补贴医保方案。

Dr. Hasan's sales pitch to these companies was that health is a right and this is a way for the companies to help their low-income employees. For their domestic staff his pitch was: If a maid or a baby sitter of an executive fell ill, it would disrupt that executive's productivity in the office for as long as it took for the problem to be resolved.

哈桑在向这些公司推介自己的项目时说，健康是一种权利，而这个项目为企业提供了帮助低收入员工的途径。关于为何要为家政人员提供医保，哈桑说服对方的理由是，如果一位高管家里的女佣或是保姆生病了，那么在问题解决之前，企业高管的工作效率会受到影响。

But the program is under scrutiny from the country's insurance regulator, which comes under the jurisdiction of the Securities and Exchange Commission of Pakistan.

不过，这个项目目前正在受到巴基斯坦保险业监管机构的审查，巴基斯坦保险业监管机构隶属于巴基斯坦证券交易委员会(Securities and Exchange Commission of Pakistan，简称：SECP)。

Mohammed Asif Arif, the insurance division commissioner at the SECP, said that Naya Jeevan is in violation of the country's insurance laws because it isn't registered as a broker and can't legally offer these products. The regulator issued a notice in September to insurance companies reminding them that it is illegal to sell insurance to unregistered entities. (Naya Jeevan buys insurance in bulk at discounted rates from several insurance companies.)

SECP保险监管部门专员阿里夫(Mohammed Asif Arif)说，Naya Jeevan违反了巴基斯坦的保险法，因为它没有注册成为代理机构，因此没有资格提供这些产品。SECP今年9月向保险公司下发了一则通知，警告这些公司，向非注册实体销售保险属违法行为（Naya Jeevan从一些保险公司那里以折扣价整批购买保险产品。）

Mr. Asif Arif said his agency would allow Naya Jeevan time to comply with the rules, without offering a specific deadline.

阿里夫说，SECP将给予Naya Jeevan时间达到法律规定的要求，但没有透露具体期限。

'I don't think we are in direct violation of the rules,' said Fahad Khawaja, Naya Jeevan's medical services manager. 'We have a small profile, we are still running in loss, it is not justified for the SECP to push us. But we are still trying to comply and get registered.'

Naya Jeevan的医疗服务经理赫瓦贾(Fahad Khawaja)说，我认为我们并没有违反规定。我们的规模很小，还在亏本经营，SECP不应该给我们施加压力。不过，我们正在努力符合规定并进行注册。

Naya Jeevan said that it hasn't had to discontinue any of its services, but the insurance companies have warned it that they are under pressure from the regulator to not work with unregistered units. The company describes itself as a not-for-profit social enterprise, but it is in the process of converting itself into a for-profit company.

Naya Jeevan说，该机构目前还不需要中断任何服务，但是保险公司已经警告说，监管机构要求它们不要与未注册的机构合作。Naya Jeevan称自己是非盈利社会企业，但是正在转型为以营利为目的的公司。

The company said that its application for a license has been delayed because it had to first raise the minimum amount of capital required by law. It so far has received $1.27 million in donations of which $775,000 has been used to cover its operating expenses over the past three years. It said it has applied for a company license and once it has that in hand, it will apply for a brokerage license. With the company license it plans to sell its services to its corporate clients for a profit, it said, but will maintain some of its discounted services, such as for poor children.

Naya Jeevan表示，申请执照的过程之所以被耽搁，是因为首先需要筹集到法律规定的最低资金额。该公司目前已经收到了127万美元的捐款，其中77.5万美元已经被用于支付其过去三年的经营费用。Naya Jeevan说，已经申请了公司执照，一旦拿到营业执照，该公司将会申请从事代理业务的执照。获得执照后，该公司计划向企业客户销售服务，从而获得利润，但是仍然会保留一些低价的服务，比如说针对贫穷儿童的低价服务。

Dr. Hasan started Naya Jeevan with $75,000 that he won in 2008 in a New York University Social Entrepreneurship competition. Since then he has received funding from the International Labor Organization, USAID, the Asia Foundation, Google/Tides Foundation and J.P. Morgan Chase JPM -0.59% .

哈桑用7.5万美元创办了Naya Jeevan，这7.5万美元是他2008年在纽约大学社会企业家竞赛(New York University Social Entrepreneurship)中获得的奖金。此后，他又得到了国际劳工组织(International Labor Organization)、美国国际发展署(USAID)、亚洲基金会(Asia Foundation)、Google/Tides 基金会和摩根大通(J.P. Morgan Chase )的捐款。

Naya Jeevan has locked in subsidized rates with a handful of Pakistani insurance companies. Under the agreements, it costs a company $1.50 a month per employee to enroll its lower-income employees and home helpers such as janitors, drivers and maids. Of this amount, at least 80% is typically covered by the company and the rest by the employee who is being covered. These employees also can enroll their families in the insurance program, at an additional monthly cost to them of up to $1.50 a person.

巴基斯坦的一些保险公司已经同意为Naya Jeevan提供折扣。根据Naya Jeevan和一些保险公司的协议，企业只需每月为每名员工支付1.5美元，就可以让该企业的低收入员工以及门卫、司机和女佣等家政服务员参加医保。公司一般支付保费的至少80%，其余由员工本人支付。这些员工还可以帮助他们的家人参保，只需每月额外支付最多1.5美元的费用。

If a claim exceeds the amount of an individual policy, the balance of the cost is paid for by the individual's corporate employer. Naya Jeevan says 17,000 people are enrolled in its program.

如果索赔超过了保单的赔付额度，多出的数额将由雇主支付。Naya Jeevan说，已经有1.7万人参加了这一项目。

One company that has signed up with Naya Jeevan and is encouraging its employees to insure their own domestic help is Unilever Pakistan Ltd. Under the Naya Jeevan plan, Unilever ULVR.LN +0.50% employees can enroll their domestic help in the health-insurance programs at a cost of $2 a month. The beneficiary pays no more than 20% of that.

联合利华巴基斯坦股份有限公司(Unilever Pakistan Ltd.)是与Naya Jeevan达成协议、并鼓励员工为家政服务员投保的公司之一。根据Naya Jeevan的方案，联合利华巴基斯坦的员工可以让家政服务员参与到医保项目中，价格是每月2美元。受益人支付的比例不超过20%。

'The biggest challenge is the mind-set,' Dr. Hasan said. 'A lot of affluent people are still stuck in the master-slave attitude.'

哈桑说，最大的挑战是人们的观念，许多富人的观念中，主仆概念仍然根深蒂固。

That extends to the hospitals as well.

医院的工作人员也存在这种观念。

'One of the issues in society is that when you send in a low-income person to a gleaming fancy hospital, they may not get treated properly,' even though their treatment is covered by the insurance program, Dr. Hasan said. To prevent that, Naya Jeevan works with doctors who can liaise with hospitals on behalf of their patients.

哈桑说，有这样一个社会问题：如果你把一个低收入者送到一个豪华的医院，那么这个低收入者可能并不能得到适当的治疗，即使保险公司会支付他的费用。为了防止这种状况发生，Naya Jeevan正在与能够代表病人与医院沟通联络的医生合作。

Dr. Hasan said his next step is to take this program to other developing countries, including the neighboring country of India, which has a similar health-care system─and problems─as Pakistan.

哈桑说，他的下一步计划是把这个项目推广到其他发展中国家，包括邻国印度。印度的医保体系与巴基斯坦类似，也存在着类似的问题。