在美国，除了几近饱和的医院，疗养院也成为新冠肺炎感染者的主要收治地。为了给新冠患者腾出更多床位，许多疗养院里原先的住户已被院方清空。然而，美国疗养院近日被爆，其无情“踢走”非新冠病人的原因，除了缓解新冠收治压力，竟是为了获得更多包括政府补贴在内的经济收益。 两种模式：联邦医疗保险与联邦医疗补助 在美国，疗养院的主要收入来源是接收手术或急性疾病后的康复病人。但由于不同类型的保险项目意味着不同的收入，美国的疗养院长期以来倾向于根据病人有“多值钱”对他们进行分类。 联邦医疗保险是一项主要针对短期康复的联邦计划，联邦医疗补助是另一种可为穷人提供长期医疗保障的公共计划。然而，在美国，疗养院从联邦医疗保险中得到的补贴比联邦医疗补助要高得多。 2019年的一项研究发现，平均而言，联邦医疗补助每天为每位病人支付给疗养院214美元，而联邦医疗保险每天的平均补助额是523美元。 因此疗养院更欢迎通过私人保险或联邦医疗保险支付费用的病人，而那些通过联邦医疗补助长期居住的穷人，则可能会因此成为牺牲品，为那些“更值钱”的病人腾出空间 。 On the one hand, patients going through post-surgery rehabilitation and expected to pay through Medicare, a federal program for the elderly and the disabled, are likely to find their stays more welcomed. On the other hand, those committed to long-term residence using Medicaid, the other public option that covers the poor, may nevertheless become expendable should the facility decide to make room for the former group. What contributes to this unspoken prejudicial policy is the much higher rate of reimbursement nursing homes receive from Medicare than Medicaid. A study last year found that on average Medicaid paid nursing homes $214 a day per resident, while the average Medicare reimbursement was $523 a day. 新冠肺炎大流行使这个问题变得更加严重 新冠肺炎加剧疗养院问题 新冠肺炎大流行使得疗养院对联邦医疗保险持有人的偏好进一步加强。 2019年，联邦医疗保险支付疗养院费用的方案进行了调整，收留病情较重的短期康复病人变得更有利可图。随着新冠病毒感染病例在全美飙升，比起接收联邦医疗补助病人，收治持有联邦医疗保险的新冠肺炎患者，可以帮助疗养院每天多赚600美元。 为了获得更多金钱收益，这些疗养院清退了那些为他们带来较少收益的住户。据报道，在新冠肺炎大流行期间，至少有6400名疗养院住户被非自愿地清退出院，其中许多人被转移到了无家可归者收容所。 With coronavirus cases soaring throughout the country, nursing homes have been expecting the inflated admission of patients who fit the more profitable type. By admitting someone infected by COVID-19 who has Medicare, they can make $600 more per day than by having a Medicaid beneficiary as a resident. The motivation to generate more profits led to the eviction of those contributing less to nursing homes' financial gains. Employees and doctors of some nursing facilities told the Times that they believed the reason for the recent evictions indeed had a financial layer. Others confirmed that making room for COVID-19 patients was the objective. 疗养院的逐利性 除了从联邦医疗保险持有人那里获得更多收益，接收新冠肺炎患者也会让疗养院从联邦和州政府获得更多金钱奖励。 在加州，为激励护理机构接收新冠肺炎患者，社会服务部每天向他们提供高达1000美元的激励，密歇根州则向计划改造为新冠患者“收治中心”的护理机构支付每个床位5000美元的费用。美国各地的一些疗养院，如今已经收到了美国卫生及公共服务部提供的数十万美元的新冠患者收治资金。 California's Department of Social Services offered up to $1,000 a day for nursing facilities to admit those who tested positive for the coronavirus. In Michigan, the state provided $5,000 per bed upfront to facilities planning to remodel themselves into COVID-19 "hubs." Across the country, nursing homes have been the recipient of several hundred thousand dollars from the U.S. Department of Health and Human Services for coronavirus relief. 但是，尽管有资金注入，疗养院的经营者们似乎并没有把钱花在防止新冠病毒在员工和住户中传播上。 在美国，疗养院是出现新冠肺炎死亡病例最多的机构之一。据福布斯报道，每十名死于新冠肺炎的人中，就有四人是疗养院或护理机构的住户或工作人员。 在全美范围内，疗养院内病毒传染防御措施不足和人员短缺问题已被广泛报道。尽管研究表明，聘用更多有资质的护士，或加强病毒传染防御，对减少新冠肺炎死亡病例至关重要，然而，从经济层面讲，这并不符合疗养院的利益 。 But despite the cash infusion, nursing homeowners seem unmotivated to spend it on things that could have helped prevent the spread of the virus among staff and residents. Throughout the country, deficiencies of infection control and staffing shortage in nursing homes have been widely reported. Yet financially speaking, it is not in their interest to hire more registered nurses or improve the conditions of virus containment, even though studies suggest they have been crucial in minimizing COVID-19 casualties. Over the years, what has been attracting their monetary devotion is the offer of extra services through which they could charge more fees. 当全世界都因新冠肺炎而饱受折磨之时，疗养院被看作是治愈之所。然而，对许多美国疗养院来说，当金钱收益被放在天平一端时，另一端的砝码是什么已经无关紧要了。