双语阅读｜试管授精不只是生育问题，更是财务大事

IN 2016, 71,000 babies were born in America after in vitro fertilisation (IVF), triple the number two decades earlier and 1.8% of all births. The share of births that are by IVF varies around the world, rising as high as 4% in Denmark, Israel and Spain. One consistent trend, however, is growth. Fertility technology is steadily improving and women are choosing to delay child-bearing, meaning more couples need medical help to conceive.

2016年，美国有71000名试管婴儿出生，是20年前的三倍，占新生儿的1.8%。在全球，试管婴儿的占比不尽相同，丹麦、以色列和西班牙三国的比例高达4%。然而，总的来说，增长是不变的趋势。生育技术正在稳步改善，女性在选择推迟生育，这意味着更多的夫妇需要医疗帮助才能怀孕。

For many would-be parents the main impediment to conception is now not science but finance. Data for 2017 gathered by ICMART, an international non-profit organisation, show vast variation in prices. A single IVF attempt costs around $3,000 in Japan, $4,000 in Cameroon and up to $10,000 in Europe. In America it costs more. The countries with the highest IVF birth rates are those where taxpayers pay for treatment. (There are a few exceptions, such as Croatia, where medical tourism pushes the IVF birth rate up.)

对于许多准父母而言，如今阻碍受孕的主要因素不是科学问题，而是金融问题。据国际非营利组织ICMART收集的2017年数据显示，试管授精费用差异巨大。在日本一次试管授精的费用约为3000美元，在喀麦隆约为4000美元，在欧洲则高达10000美元，美国的费用则更高。在试管婴儿占比最高的国家，医疗费用由纳税人自己支付。(也有一些例外，比如克罗地亚的医疗旅游业推高了试管婴儿的出生率。)

A three-year-old startup, Carrot, is taking a novel approach to helping with the costs. It was born out of the experience of its co-founder and CEO, Tammy Sun, who was startled to realise that the health-insurance plan offered by the technology firm where she worked would offer no support for her own efforts at conception. After $35,000 yielded a dozen fertilised eggs, one of which will, she hopes, one day make her a mother, she decided to think through the funding of fertility treatment from first principles. What was needed, she concluded, was not only help paying for it but also certainty upfront about how much money she would get.

Carrot是一家成立三年的创业企业，正采取一种新颖方法解决医疗费用问题。Carrot的成立是由于其联合创始人兼首席执行官Tammy Sun的自身经历。Tammy Sun惊讶地发现，她工作的科技企业提供的医疗保险不支付她的受孕费用。在花了35000美元排出十多个打受精卵后，她希望有一个能让她有一天能成为母亲，于是，她决定从源头考虑生育治疗的资金问题。她发现，人们需要的不仅是帮助支付费用，还需要预先确定能拿到多少钱。

Such transparency is unusual for American health insurance, which requires a muddle of out-of-pocket payments, if it offers coverage at all. Patients do not know how much they will get back from insurers until much later. It is also different from public health-care systems, which often restrict coverage in other ways. In Britain, for example, eligibility rules vary from place to place and waiting-lists are long. Patients rarely know they will not be covered until they have asked and been turned down.

这种透明度在美国健康保险中不常见，即使包含在保险提供的范围内，大部分也需自掏腰包。病人需要很长时间才能得知保险公司的赔付额。这又与公共卫生保健系统不同，后者经常以其他方式限制保险范围。例如，在英国，申请资格的规则因地而异，申请人数较多。病人只有在询问或是遭拒的时候，才知道费用不包含在保险当中，否则无从知道。

Carrot’s answer is to act as an intermediary for fertility-related medical-service providers to American companies and their foreign operations in 22 countries; Poland and Singapore are next on its list. Carrot collects and shares information on costs and results, which companies use to set up benefits, and employees to shop around. It charges firms an administrative fee, and they offer their employees a fixed sum, ranging from $2,000 to $100,000, averaging $10,000, that can be used for IVF and related services. (In most countries, corporate benefits can be claimed by any employee regardless of sex, sexual orientation or marital status, as long as they are used for eligible services; the exceptions are where that would break national law, such as a French ban on IVF for same-sex couples and a Japanese ban on IVF for unmarried couples.)

Carrot的解决办法是充当中介，为美国企业及其海外机构提供生育相关医疗服务，而波兰和新加坡之后也会列入服务名单。该公司汇总并分享有关费用和治疗结果的信息，其它企业用这些信息来设立福利，员工可以购买。Carrot向其他企业收取管理费，后者向员工提供一笔固定资金，从2000美元到10万美元不等，平均1万美元；员工可以将这笔钱用于试管授精及其它相关服务。（在大多数国家，无论其性别、性取向或婚姻状况如何，只要用于符合条件的服务，任何员工都可以申请企业福利。但不包括违反国家法律的行为，比如法国禁止同性伴侣试管授精，以及日本禁止未婚夫妇试管授精。）

Since users can be certain of their benefits, they know exactly how much treatment they can afford. The same applies to firms: they know how much they will be on the hook for. Carrot’s clear cap on payments means that would-be parents may run out of money before they conceive. But at least it is transparent about it—unlike many alternative systems.

由于明确知道福利所在，用户确切地了解所承担的治疗费用。企业也同样如此：他们可以知道要拿出多少钱。Carrot明确支付上限意味着准父母可能在怀孕前就不够钱。至少它是透明公开的，而不像许多其它医疗体系。

编译：贾毅荣

编辑：翻吧君