ABOUT THE SPEAKER
P.J. Parmar - Physician
Physician P.J. Parmar founded Ardas Family Medicine, a private practice that serves resettled refugees, and Mango House, a home for refugees with activities and services that include dental care, food and clothing banks, churches, scout troops and afterschool programs.

Why you should listen

P.J. Parmar is a family doctor who started and runs a primary care clinic, dental clinic, youth programs and other endeavors for resettled refugees in the Denver area. He focuses on process efficiencies in underserved primary care medicine and challenges the notion that private practices can't thrive while serving low-income patients. He has also been covered widely for his work founding a Boy Scout Troop for resettled refugees.

More profile about the speaker
P.J. Parmar | Speaker | TED.com
TEDxMileHigh

P.J. Parmar: How doctors can help low-income patients (and still make a profit)

PJ Parmar: 医生如何帮助低收入病人(且仍能盈利)

Filmed:
1,732,000 views

现代美国医疗的收费极高、间接支出也高并且难以获得——尤其对低收入患者而言。假如我们能重新设计这个系统,让它为穷人服务,同时还能让医生赚钱会怎样?在一次令人大开眼界(也出人意料的有趣)的谈话中,内科医生PJ Parmar分享了他在科罗拉多州创建的诊所的故事。在那里,他只为主要使用医疗补助的新定居的难民提供服务。
- Physician
Physician P.J. Parmar founded Ardas Family Medicine, a private practice that serves resettled refugees, and Mango House, a home for refugees with activities and services that include dental care, food and clothing banks, churches, scout troops and afterschool programs. Full bio

Double-click the English transcript below to play the video.

00:13
Colfax科尔法克斯 Avenue大街, here in Denver丹佛, Colorado科罗拉多州,
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科尔法克斯大道位于科罗拉多州丹佛市,
曾被称为美国“最长,最邪恶的街道”。
00:17
was once一旦 called the longest最长,
wickedest威克塞斯特 street in America美国.
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00:22
My office办公室 is there in the same相同 place地点 --
it's a medical desert沙漠.
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我的办公室就在那儿——
那片医疗资源极度匮乏的地区。
00:26
There are government政府 clinics诊所
and hospitals医院 nearby附近,
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虽然附近有政府诊所和医院,
但根本不够医治这个地区的穷人。
00:28
but they're not enough足够 to handle处理
the poor较差的 who live生活 in the area.
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我所说的穷人是指
那些接受医疗补助的人。
00:31
By poor较差的, I mean those who are on Medicaid医疗补助.
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不仅指无家可归的人;
美国有20%的人都接受医疗补助。
00:34
Not just for the homeless无家可归;
20 percent百分 of this country国家 is on Medicaid医疗补助.
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00:38
If your neighbors邻居 have a family家庭 of four
and make less than $33,000 a year,
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如果你邻居家有四口人,
年收入不到33,000美元,
那么他们就能获得医疗补助。
00:42
then they can get Medicaid医疗补助.
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00:44
But they can't find a doctor医生 to see them.
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然而他们却找不到医生治病。
00:47
A study研究 by Merritt梅里特 Hawkins霍金斯
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梅里特霍金斯公司做的
00:48
found发现 that only 20 percent百分
of the family家庭 doctors医生 in Denver丹佛
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一个研究发现,
丹佛只有20%的家庭医生
接受使用医疗补助的病人。
00:51
take any Medicaid医疗补助 patients耐心.
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00:53
And of those 20 percent百分, some have caps帽子,
like five Medicaid医疗补助 patients耐心 a month.
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在这20%的医生中,有的有数量限制,
比如一个月看5位医疗补助病人。
00:59
Others其他 make Medicaid医疗补助 patients耐心
wait months个月 to be seen看到,
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有些医生则让使用医疗补助的
病人等上几个月,
但如果你有蓝十字医疗险,
你今天就能接受治疗。
01:02
but will see you today今天,
if you have Blue蓝色 Cross交叉.
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01:06
This form形成 of classistclassist
discrimination区别 is legal法律
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这种阶级歧视是合法的,
并且不仅丹佛存在这个问题。
01:09
and is not just a problem问题 in Denver丹佛.
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01:12
Almost几乎 half the family家庭
doctors医生 in the country国家
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几乎一半的美国家庭医生
都拒绝接收使用医疗补助的病人。
01:14
refuse垃圾 to see Medicaid医疗补助 patients耐心.
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01:17
Why?
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为什么?
因为医疗补助支付的金额比私人保险低,
01:18
Well, because Medicaid医疗补助 pays支付 less
than private私人的 insurance保险
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而且人们总觉得接收
使用医疗补助的病人更麻烦。
01:21
and because Medicaid医疗补助 patients耐心
are seen看到 as more challenging具有挑战性的.
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01:26
Some show显示 up late晚了 for appointments约会,
some don't speak说话 English英语
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他们有些人会迟到,有些人不会说英语,
有些人在遵循医嘱上也存在困难。
01:28
and some have trouble麻烦
following以下 instructions说明.
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01:32
I thought about this
while in medical school学校.
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在医学院时我就想过这些问题。
01:36
If I could design设计 a practice实践
that caters迎合 to low-income低收入 folks乡亲
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如果我能设计出一个适合低收入人群
而非拒绝他们的医疗模式
01:40
instead代替 of avoiding避免 them,
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那么我的客源就有保证,而且竞争很小。
01:42
then I would have guaranteed保证 customers顾客
and very little competition竞争.
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(笑声)
01:47
(Laughter笑声)
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所以在住院医生实习结束后,我开了
一家服务低医疗服务水平人群的诊所。
01:48
So after residency住院医师, I opened打开 up shop,
doing underserved缺医少药 medicine医学.
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不是非盈利组织,而是私人诊所。
01:53
Not as a nonprofit非营利性,
but as a private私人的 practice实践.
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01:56
A small business商业
seeing眼看 only resettled安置 refugees难民.
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一个小生意,只为重新安置的难民看病。
02:02
That was six years年份 ago,
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那是在6年前,
自那之后,我们已经为
5万难民提供了医疗服务。
02:03
and since以来 then, we've我们已经 served提供服务
50,000 refugee难民 medical visits访问.
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(鼓掌)
02:06
(Applause掌声)
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02:14
Ninety九十 percent百分 of our patients耐心
have Medicaid医疗补助,
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我们的病人中90%有医疗补助,
对其他剩下的大部分人,
我们提供免费诊疗。
02:17
and most of the rest休息, we see for free自由.
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02:19
Most doctors医生 say you can't
make money on Medicaid医疗补助,
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很多医生说你无法
在使用医疗补助的病人身上赚钱,
但我们的收入还不错。
02:22
but we're doing it just fine.
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如何做到的呢?
02:24
How?
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02:25
Well, if this were real真实 capitalism资本主义,
then I wouldn't不会 tell you,
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如果这是资本主义,我可不会告诉你,
因为你们会成为我的竞争对手。
02:28
because you'd become成为 my competition竞争.
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(笑声)
02:30
(Laughter笑声)
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但我把这称为“软心肠”的资本主义。
02:31
But I call this
"bleeding-heart流血的心" capitalism资本主义.
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(笑声)
02:34
(Laughter笑声)
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我们需要更多的人参与进来,
我们是这么做的。
02:35
And we need more people doing this,
not less, so here's这里的 how.
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我们把服务使用医疗补助的病人的
02:40
We break打破 down the walls墙壁
of our medical maze迷宫
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挑战转化为机会,
02:43
by taking服用 the challenges挑战
of Medicaid医疗补助 patients耐心,
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并从中赚取差价,来解开我们的医疗谜题。
02:45
turning车削 them into opportunities机会,
and pocketing扒窃 the difference区别.
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02:50
The nuts坚果 and bolts螺栓
may可能 seem似乎 simple简单, but they add up.
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螺母和螺栓看起来很简单,
但它们加起来却能发挥巨大的作用。
比如,我们无需预约。
02:53
For example, we have no appointments约会.
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02:56
We're walk-in走在 only.
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我们采取即到即诊的模式。
02:58
Of course课程, that's how it works作品
at the emergency room房间,
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也就是说,急诊室和
塔可钟(墨西哥快餐品牌)
采用了相同的模式。
03:01
at urgent紧急 cares管它 and at Taco塔科 Bell.
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03:04
(Laughter笑声)
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(笑声)
但这些在家庭医生的办公室并不常见。
03:05
But not usually平时
at family家庭 doctor's医生 offices办事处.
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03:08
Why do we do it?
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我们为什么要这样做?
03:10
Because Nasra纳斯拉 can't call
for an appointment约定.
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因为像纳斯拉这样的人没法预约。
她有电话,但她没钱付话费。
03:13
She has a phone电话, but she
doesn't have phone电话 minutes分钟.
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她不会说英语,也不会查询通讯录。
03:17
She can't speak说话 English英语,
and she can't navigate导航 a phone电话 tree.
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03:21
And she can't show显示 up on time
for an appointment约定
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她无法在预约时间准时出现,
因为她没有私家车,她需要乘坐公车,
03:23
because she doesn't have a car汽车,
she takes the bus总线,
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并且她需要照顾3个小孩
外加她残疾的父亲。
03:26
and she takes care关心 of three kids孩子
plus her disabled father父亲.
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03:30
So we have no appointments约会;
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所以我们不提供预约服务;
她想来的时候就来,
03:31
she shows节目 up when she wants,
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通常等待不到15分钟就能就诊。
03:33
but usually平时 waits等待 less
than 15 minutes分钟 to be seen看到.
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03:37
She then spends as much time
with us as she needs需求.
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我们会充分保证她的就诊时长。
03:41
Sometimes有时 that's 40 minutes分钟,
usually平时 it's less than five.
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有时候是40分钟,但通常不到5分钟。
03:45
She loves this flexibility灵活性.
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她喜欢这种弹性。
她在索马里就是这样看医生的。
03:47
It's how she saw doctors医生 in Somalia索马里.
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03:50
And I love it, because I don't pay工资
staff员工 to do scheduling调度,
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这也让我很开心,因为我不需要
额外雇人负责预约事项,
我们的爽约率和迟到率为零。
03:53
and we have a zero no-show无显示 rate
and a zero late-show后期演出 rate.
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(笑声)
03:56
(Laughter笑声)
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03:59
(Applause掌声)
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(鼓掌)
这很有商业价值。
04:04
It makes品牌 business商业 sense.
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04:06
Another另一个 difference区别 is our office办公室 layout布局.
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另一个不同是我们办公室的布局。
我们的检查室和候诊室相通,
04:09
Our exam考试 rooms客房 open打开
right to the waiting等候 room房间,
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每个医生都和他们自己的
病人独享一个房间,
04:11
our medical providers供应商
room房间 their own拥有 patients耐心,
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我们的服务人员集中在一个房间里,
而不需要在两个房间之间来回穿梭。
04:14
and our providers供应商 stay in one room房间
instead代替 of alternating交替 between之间 rooms客房.
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04:19
Cutting切割 steps脚步 cuts削减 costs成本
and increases增加 customer顾客 satisfaction满意.
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削减流程降低了成本,提高了客户满意度。
04:24
We also hand out free自由 medicines药品,
right from our exam考试 room房间:
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我们还在诊室分发免费药品:
非处方药和一些处方药。
04:28
over-the-counter在柜台 ones那些
and some prescription处方 ones那些, too.
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如果纳斯拉的孩子病了,
04:31
If Nasra's纳斯拉的 baby宝宝 is sick生病,
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我们会直接给她一瓶
儿童泰诺或阿莫西林。
04:33
we put a bottle瓶子 of children's儿童 Tylenol泰诺
or amoxicillin阿 莫 西林 right in her hand.
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她可以直接带孩子回家,
而无需再去药店。
04:37
She can take that baby宝宝 straight直行 back home
instead代替 of stopping停止 at the pharmacy药店.
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04:43
I don't know about you, but I get sick生病
just looking at all those choices选择.
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我不知道你们怎么想,
但我一见到这一大堆药就头晕。
04:47
Nasra纳斯拉 doesn't stand a chance机会 in there.
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纳斯拉根本没法在这里买药。
04:51
We also text文本 patients耐心.
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我们也给病人发短信。
04:53
We're open打开 evenings晚上 and weekends周末.
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我们晚上和周末都营业。
我们做家访。
04:55
We do home visits访问.
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我们把汽车电池都跑到没电了。
04:56
We've我们已经 jumped跳下 dead car汽车 batteries电池.
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(笑声)
04:58
(Laughter笑声)
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有这么高的客户满意度,
我们根本不用打广告,
05:00
With customer顾客 satisfaction满意 so high,
we've我们已经 never had to advertise广告,
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还能以每年25%的速度增长。
05:04
yet然而 are growing生长 at 25 percent百分 a year.
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05:08
And we've我们已经 become成为 real真实 good
at working加工 with Medicaid医疗补助,
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我们变得很熟悉Medicaid的业务,
因为它几乎是我们
唯一合作的保险公司。
05:11
since以来 it's pretty漂亮 much the only
insurance保险 company公司 we deal合同 with.
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05:14
Other doctor's医生 offices办事处
chase 10 insurance保险 companies公司
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其他医生的诊所同时
与10家保险公司合作
以实现收支平衡,
05:17
just to make ends结束 meet遇到.
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但收效甚微。
05:19
That's just draining排水.
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05:21
A single-payer单付款人 system系统 is like monogamy一夫一妻制:
it just works作品 better.
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单一支付方制度就像一夫一妻制:
它就是效果更好。
05:25
(Laughter笑声)
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(笑声)
(鼓掌)
05:27
(Applause掌声)
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当然,医疗补助计划由像
你们这样的纳税人资助,
05:31
Of course课程, Medicaid医疗补助 is funded资助
by tax payers纳税人 like you,
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所以你们可能会好奇,
“这个系统要花多少钱?”
05:35
so you might威力 be wondering想知道,
"How much does this cost成本 the system系统?"
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我们比主流方案便宜。
05:38
Well, we're cheaper便宜 than the alternatives备择方案.
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05:41
Some of our patients耐心
might威力 go to the emergency room房间,
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我们有些病人去急诊室,
仅仅一个简单的感冒,
就要花数千美元。
05:43
which哪一个 can cost成本 thousands数千,
just for a simple简单 cold.
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05:46
Some may可能 stay home
and let their problems问题 get worse更差.
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有些人则呆在家中,坐等问题恶化。
05:50
But most would try to make an appointment约定
at a clinic诊所 that's part部分 of the system系统
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但是大多数人会尝试在
属于联邦授权医疗中心的
一个诊所预约。
05:56
called the Federally联邦
Qualified合格 Health健康 Centers中心.
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06:00
This is a nationwide全国 network网络
of safety-net安全网 clinics诊所
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这是一个覆盖全国的诊所安全网络,
每次看病得到的政府资助
06:04
that receive接收 twice两次 as much
government政府 funding资金 per visit访问
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是像我这样的私人医生的两倍。
06:08
than private私人的 doctors医生 like me.
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06:11
Not only they get more money,
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他们不仅收取更高的费用,
根据法律,每个地区只能有一个。
06:13
but by law, there can only be
one in each area.
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06:16
That means手段 they have a monopoly垄断
on special特别 funding资金 for the poor较差的.
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这意味着他们垄断了为穷人
提供的特殊资金。
06:21
And like any monopoly垄断,
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跟任何垄断一样,
总是成本会上升,质量会下降。
06:22
there's a tendency趋势 for cost成本 to go up
and quality质量 to go down.
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06:27
I'm not a government政府 entity实体;
I'm not a nonprofit非营利性.
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我不是政府实体,我不是非盈利组织。
06:31
I'm a private私人的 practice实践.
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我是个私人诊所。
我有资本主义的创新动力。
06:32
I have a capitalist资本家 drive驾驶 to innovate创新.
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06:35
I have to be fast快速 and friendly友善.
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我必须高效和友好。
06:39
I have to be cost-effective经济有效
and culturally文化 sensitive敏感.
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我得有成本效益和文化敏感性。
06:43
I have to be tall, dark黑暗 and handsome英俊.
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我必须又高又黑又帅。
(笑声)
06:46
(Laughter笑声)
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(鼓掌)
06:47
(Applause掌声)
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如果不具备这些,我的生意就会垮掉。
06:49
And if I'm not, I'm going out of business商业.
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我比非盈利组织在创新方面更高效,
06:52
I can innovate创新 faster更快 than a nonprofit非营利性,
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06:54
because I don't need a meeting会议
to move移动 a stapler订书机.
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因为我不需要开个会
来决定是否拆除缝合器。
06:57
(Applause掌声)
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(鼓掌)
我们的创新都不是新的或独创的——
07:03
Really, none没有 of our innovations创新
are new or unique独特 --
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我们只是用一种独特的方法
把它们组合在一起,
07:06
we just put them together一起 in a unique独特 way
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在帮助低收入人群的同时还赚钱。
07:08
to help low-income低收入 folks乡亲
while making制造 money.
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然后,我会把这些钱投入难民社区
07:11
And then, instead代替 of taking服用
that money home,
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作为商业支出,而不是拿回家。
07:13
I put it back into the refugee难民 community社区
as a business商业 expense费用.
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07:17
This is Mango芒果 House.
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这是芒果屋。
我创建的医疗之家。
07:19
My version of a medical home.
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07:21
In it, we have programs程式
to feed饲料 and clothe覆上 the poor较差的,
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在那里,我们为穷人提供食物和衣服,
提供课外项目,英语课,
07:24
an after-school放学后 program程序, English英语 classes,
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教堂,牙医,法律援助,
心理辅导和童子军等项目。
07:27
churches教堂, dentist牙医, legal法律 help,
mental心理 health健康 and the scout侦察 groups.
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07:33
These programs程式 are run
by tenant承租人 organizations组织
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这些项目由承租组织
和出色的员工运作,
07:36
and amazing惊人 staff员工,
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但他们都从我的诊所获得了一些资金。
07:38
but all receive接收 some amount of funding资金
form形成 profits利润 from my clinic诊所.
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07:45
Some call this social社会 entrepreneurship创业.
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有人称之为社会企业家精神。
07:49
I call it social-service社会服务 arbitrage套利.
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我称之为社会服务套利。
07:52
Exploiting开发 inefficiencies低效 in our
health健康 care关心 system系统 to serve服务 the poor较差的.
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利用我们卫生保健系统的
低效率为穷人服务。
07:57
We're serving服务 15,000 refugees难民 a year
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我们每年服务15,000位难民,
且比其他地方花费更少。
08:00
at less cost成本 than where else其他
they would be going.
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08:05
Of course课程, there's downsides缺点
to doing this as a private私人的 business商业,
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当然,作为私人企业,
既非非盈利组织,也非政府实体,
做这个也有不利的一面。
08:08
rather than as a nonprofit非营利性
or a government政府 entity实体.
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有税收和法律风险。
08:10
There's taxes and legal法律 exposures曝光.
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08:14
There's changing改变 Medicaid医疗补助 rates利率
and specialists专家 who don't take Medicaid医疗补助.
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有不断变化的医疗补助率和
不接受医疗补助病人的专家。
08:19
And there's bomb炸弹 threats威胁.
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还有炸弹威胁。
08:22
Notice注意 there's no apostrophes撇 号, it's like,
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请注意,这里少了个标点符号,
所以表达的意思就变成了,
“我们本来要炸掉你们这些难民!”
08:25
"We were going to blow打击 up
all you refugees难民!"
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08:27
(Laughter笑声)
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(笑声)
“我们本来要炸掉你们这些难民,
08:33
"We were going to blow打击 up
all you refugees难民,
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但后来我们去上了你们的英语课。”
08:35
but then we went
to your English英语 class, instead代替."
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(笑声)
08:37
(Laughter笑声)
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(鼓掌)
08:41
(Applause掌声)
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08:47
Now, you might威力 be thinking思维,
"This guy's家伙 a bit different不同."
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现在,你可能在想,
“这家伙的确有一套。”
(笑声)
08:50
(Laughter笑声)
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罕见。
08:51
Uncommon罕见.
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(笑声)
08:52
(Laughter笑声)
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一个公共自恋者?
08:53
A communal公社 narcissist自恋者?
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(笑声)
08:55
(Laughter笑声)
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也许还是独角兽,
08:56
A unicorn独角兽, maybe,
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但如果这么简单的话,
其他医生也会这样做。
08:57
because if this was so easy简单,
then other doctors医生 would be doing it.
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09:01
Well, based基于 on Medicaid医疗补助 rates利率,
you can do this in most of the country国家.
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根据医疗补助率,你可以在
全国大部分地区这样做。
你可以做自己的老板,
09:04
You can be your own拥有 boss老板,
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帮助穷人并赚大钱。
09:06
help the poor较差的 and make
good money doing it.
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医学院的人
09:09
Medical folks乡亲,
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可能在申请学校时说过
09:10
you wrote on your school学校
application应用 essays随笔
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2016
你想帮助那些不幸的人。
09:12
that you wanted to help
those less fortunate幸运.
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但你的理想情怀在训练过程中丢掉了。
09:15
But then you had your idealism唯心主义
beaten殴打 out of you in training训练.
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09:18
Your creativity创造力 bred孕育 out of you.
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你的创造力不复存在了。
09:21
It doesn't have to be that way.
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你们本可以做得更好。
09:24
You can choose选择 underserved缺医少药 medicine医学
as a lifestyle生活方式 specialty专业.
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你可以选择医疗服务不足的
领域作为毕生专业。
09:29
Or you can be a specialist专家
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或者你可以选择成为
降低成本,为低收入人群看病的专家。
09:30
who cuts削减 cost成本 in order订购 to see
low-income低收入 folks乡亲.
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09:34
And for the rest休息 of you,
who don't work in health健康 care关心,
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对不从事医疗保健行业的其他人来讲,
你的申请表是怎么写的?
09:37
what did you write on your applications应用?
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我们大部分人想要
拯救世界,改变现状。
09:39
Most of us wanted to save保存 the world世界,
to make a difference区别.
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09:43
Maybe you've been
successful成功 in your career事业
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你们也许在你们的职业中已足够成功,
现在正在寻找生活的意义?
09:45
but are now looking for that meaning含义?
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09:48
How can you get there?
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你如何能够实现那个目标?
09:51
I don't just mean giving
a few少数 dollars美元 or a few少数 hours小时;
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我指的不是捐献一些钱或几个小时;
我的意思是你如何使用你的专业技能,
以新的方式去服务他人?
09:54
I mean how can you use your expertise专门知识
to innovate创新 new ways方法 of serving服务 others其他.
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这可能没你想的那么难。
10:00
It might威力 be easier更轻松 than you think.
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10:03
The only way we're going to bridge
the underserved缺医少药 medicine医学 gap间隙
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我们能够弥补医疗服务不足的唯一方法
是将其视为商业机会。
10:06
is by seeing眼看 it as a business商业 opportunity机会.
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我们缩小不平等差距的唯一途径
10:08
The only way we're going to bridge
the inequality不等式 gap间隙
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是认识到我们的特权,
并利用这些特权帮助他人。
10:11
is by recognizing认识 our privileges特权
and using运用 them to help others其他.
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10:16
(Applause掌声)
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(鼓掌)
Translated by jacks jun
Reviewed by Danyang Luo

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ABOUT THE SPEAKER
P.J. Parmar - Physician
Physician P.J. Parmar founded Ardas Family Medicine, a private practice that serves resettled refugees, and Mango House, a home for refugees with activities and services that include dental care, food and clothing banks, churches, scout troops and afterschool programs.

Why you should listen

P.J. Parmar is a family doctor who started and runs a primary care clinic, dental clinic, youth programs and other endeavors for resettled refugees in the Denver area. He focuses on process efficiencies in underserved primary care medicine and challenges the notion that private practices can't thrive while serving low-income patients. He has also been covered widely for his work founding a Boy Scout Troop for resettled refugees.

More profile about the speaker
P.J. Parmar | Speaker | TED.com