A study on the equivalence between english and vietnamese translation of insurance terms in US health insurance

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This thesis contains no material which has been accepted for the award of any other degree or diploma in any university or tertiary institution, and to the best of my knowledge and belief, neither does it contain material previously published or written by another person, except where due acknowledgement is made in the text

Signature

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On the completion of this thesis, I wish to express my deepest gratitude to my supervisor, Assoc Prof Dr Lé Hung Tién who gave me benefit of his wisdom and his expert knowledge in translation as well as his constant encouragement from the beginning stage of working out the research proposal to the final stage of writing up the thesis Without his critical comments and valuable suggestions, this study could not have been completed

I owe a special debt of gratitude to Mrs Rosemary Nguyen who helped shape the idea for my thesis, giving me her practical guidance, assisting me with data collection and sharing with me her long and varied experience in the translation of health insurance terms in the US health plans

I take this opportunity to express my sincere thank to all lecturers in Postgraduate Department at College of Foreign Languages, Vietnam National University, Hanoi for their useful lectures during my M.A course

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The need for the translation of US health plans into Vietnamese is a matter- of-fact since there are already a number of American insurer carriers operating in Vietnam, and many more are expected to enter such a potential market of more than 80 million people However, it is not an easy task at all due to sharp differences in the sub-culture of health insurance between the US and Vietnam

This thesis titled “A study on the equivalence between English and Vietnamese translation of insurance terms in US health insurance’, therefore, is an attempt to find out the differences and similarities between English HI terms and their Vietnamese equivalents, and to draw out the strategies/procedures/methods that are appropriate to the translation of HI terms in the US health plans into Vietnamese Hopefully, the research may make a contribution to the translation of HI terms and will be of some help to insurance circle, especially translators with little experience of doing the translation in the field

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1 BH: Bao hiém

2 BHYT: Bao hiém y té

3 BHSK: Bảo hiểm sức khoẻ

4 HI: Health insurance

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1 Rationale

2 Scope of the study 3 Aims of the study 4 Methods of the study 5 Design of the study PART B: DEVELOPMENT CHAPTER I: THEORETICAL BACKGROUND I 1.Terminology 1.1.1 Definition 1.1.2 General features of terminology an + +® Ff fF Ff t6 N NY N 1.1.3 Term creation

1.2 English single words and compounds in comparison with the Vietnamese ones 1.3 Translation theory 1.3.1 Definition of translation on NN 1.3.2 Translation equivalence 1.3.3 Translation methods, strategies and procedures 10 1.3.4 Technical translation 11 1.4 Translation of terminology 11 1.5 Chapter conclusion 13

CHAPTER II: THE TRANSLATION OF HEALTH INSURANCE

TERMS OF EQUIVALENCE GROUP 14

II.1 An overview of equivalence relationships in the translation of health

insurance terms 14

II.2 Classification of health insurance terms in the US health

insurance plans according to their structural patterns 17

11.2.1 Single terms 17

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II.3.2 The translation of compound terms by rank shift or transposition 11.3.3 The translation strategy which involves the deletion of “OF” 11.4 Concluding remark

CHAPTER III: THE TRANSLATION OF HEALTH INSURANCE TERMS OF NON-EQUIVALENCE GROUP

Ill.1 The source of non-equivalence problem in the translation of health insurance terms in the US health plans

III.2 The strategies, procedures and methods used in dealing with non-equivalence problem in the translation of health insurance

terms in the US health plans

III.2.1 The translation of terms by transference procedure (the use of loan words)

III.2.2 The translation of terms by paraphrase

III.2.3 The translation of terms with communicative method III.2.4 Literal translation

II.3 Concluding remarks

PART C: CONCLUSION 39

1 The terms of equivalence group 2 The terms of non-equivalence group

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Since Viet Nam has successfully gained its accession to WTO, and the Bush administration has granted Vietnam with Permanent Normal Trading Status (PNTR), a wide range of actors, including US enterprises, is expected to be here It is also envisaged that US HI providers will do business in our country, hence a demand for the translation work in the field will be inevitable The problem lies in the fact that sharp differences in the US HI and the Vietnamese one result in several diffrent HI plans between the two countries Undoubtedly, this will pose a great obstacle to translators due to their insufficient knowledge about the two different sub-cultures of health insurance They may have to squeeze their brain to convey the true essence of each kind of health plans from English in Vietnamese

In the USA, quite a few Vietnamese-American are full time employees in American companies and factories, hence eligible to HI coverage offered by their employers Annually, the companies and factories have the so-called enrollment for their employees to enroll for health benefits or to choose the health plan that best benefits them To guarantee that their employees do not end up in wrong decisions, which goes in counter with their benefits due to the failure to understand HI plans written in English, they have them translated by Vietnamese and native American translators

In Vietnam, though translators do not have to translate such HI plans for clients, they still have to translate a number of presumably popular HI terms, including many in the US HI plans for at least insurance-majored students or for training courses held by some insurance carriers

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focuses only on HI terms collected from HI plans Disability income insurance which is also a sub-type of the US HI is excluded from the study

Such is the boundary set for my thesis so as to achieve a thorough investigation Specifically, the study takes into consideration such major aspects as follows:

e classification of equivalence relationships e structural patterns of HI terms in English e their translations

3 Aims of the study

e To work out the similarities and differences between English terms and their Vietnamese equivalents

¢ To draw out the strategies/procedures/methods that may apply to the translation of HI terms, especially to the translation of non-equivalence terms in the US HI plans into Vietnamese

4 Methods of the study 4.1 Research questions

a What are the similarities and differences between English terms and their Vietnamese equivalents?

b What are strategies/procedures/methods that are appropriate to the translation of HI terms in the US insurance plans?

4.2 Research methods

On the completion of the thesis, the researcher went through the following steps: ** Building up a theoretical background by reviewing translation and terminology ** Collecting and grouping English insurance terms in the US insurance plans and

their Vietnamese equivalents for description, analysis and induction

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American translators living in the US and those in charge of translation work in Bao Viét, Pjico, Prudential, and Aoncare which are big insurer carriers in Vietnam

5 Design of the study

The study consists of three main parts, references and appendices as follows:

%

s Part A: Introduction

The rationale for the study, scope, aims, methods and design of the study are orderly presented in this part

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s Part B: Development

There are three chapters in this part: Chapter I: Theoretical background

The theory of translation and terminology will be dealt with in this chapter Chapter II: The translation of HI terms of equivalence group

This chapter features an investigation into the equivalence between English and Vietnamese translation of HI terms in the US health plans Accordingly, how HI terms in the US health plans are currently translated and what strategies/procedures/methods are employed are the focus of the research

Chapter III: The translation of HI terms of non-equivalence group

This chapter examines how non-equivalence problem in the translation of HI terms in the US health plans is solved by available translation strategies, procedures and methods

Part C: Conclusion

The conclusion summaries the strategies, procedures and methods of translation as well as makes relevant suggestions

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PART B: DEVELOPMENT

CHAPTER I: THEORETICAL BACKGROUND

I 1.Terminology 1.1.1 Definition

Terminology has been defined variously by many different linguists, either native or Vietnamese Chau, D.H (1981) claims “Zerms are specialists words used within a specific field, a profession or any technological field” To identify technical term, he states “Scientific and technical terminology consists of lexical units used to denote phenomenal objects, activities .in industrial technologies and natural or social sciences” Sharing some common features in content with the one by Chau, though put differently, the definition proposed by Giap, N.T (1998) seems to be more informative: “Terminology, understood as a special linguistic unit of language, consists of word and fixed phrase that provides precise definition and objectives that belong to particular scientific area.”

Such definitions can serve as a foundation on which we can base our distinction between terms and words In fact, Baker (1998:261) puts that “Terms differ from words in that they are endowed with a special forms of reference, namely that they refer to discrete conceptual entities, properties, activities or relations which constitute the knowledge space of a particular subject field” Accordingly, further important differences between terms and words are as follows:

1 Terms have special reference within a particular discipline whereas words function in general reference over a variety of subject fields

2 Terms keep their lives and meanings only for as long as they serve the system of knowledge they gave rise to them

In other words, terms together with words and proper names constitute the general class of lexical items Names refer individually to objects and people; words refer arbitrary boundary between terms and words is not a clear-cut, i.e many terms become ordinary words when they are used in specialized field

1.1.2 General features of terminology

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systematicism, internationalism, popularity and nationality as claimed by Giap, N.T (1998) and Lang, L.V (1977) They will be briefly presented in the next part

1.1.2.1 Accurateness

A term needs to be accurate and clear because basically it reflects an exact concept of a science If a term is of absolute accuracy, people never mistake one concept for another Once a word has become a term, it no longer has connotational, emotional meaning; it also loses its polysemousness, synonymousness and antonymousness In short, terminology necessarily works on the principle that “one concept has only one term for it, and one term indicates only one concept” This relationship is called the one-to-one equivalent between a concept and a term

1.1.2.2 Systematicism

Any field of sciences has its own limited system of concepts, which are named by a system of terms Therefore, each item has its own position in the system of concepts and belongs to a terminological system As a result, a term loses its value when isolated from system In short, a term has to be a dependent member of its system

1.1.2.3 Internationalism

Terms are used internationally because they are special words expressing common scientific concepts to people of different languages Therefore, it is useful to agree on terms to be used among languages in order to push up the development of science The international links in science result in a number of terms presented in many different languages For example, video, radio, telephone are found in French, German, English and Vietnamese with little difference in form

1.1.2.4 Popularity

Terms need to be popular in the sense that they should be close to the language of the masses, which is to say easy-to-remember, easy-to-understand and easy-to-remember, since they will help bring knowledge to and benefit men of all walks of life

1.1.2.5 Nationality

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1.1.3 Term creation

Since terms are to name concepts, so whenever a concept appears, is made in a culture, or translated to a new culture, it involves the creation of a new term to name it 1.1.3.1 Primary and secondary term creation

Primary and secondary terms formation are governed by different influences: Primary term formation occurs when a newly created concept has to be named wile secondary term formation occurs as a result of either (1) the monolingual revision of given terminology, for example, the purpose of producing a standard document, or (2) a transfer of technology to an other linguistic community-a process which requires the creation of new term in the target language

Anther fundamental differences between the two formation methods lies in the fact that in primary term formation, there is no linguistic precedent although there are rules for forming appropriate terms On the contrary, in secondary term formation, there is always the precedent of an already existing term in another language with its own motivation

Secondary term formation is more often subject to guidelines than primary term formation which are on the basis of patterns terms and words formation already prevalent in the subject field and natural language in question

(Baker, M: 1998) 1.1.3.2 Guidance on the creation of terms

Terms should consistently reflect some key features of the concepts they are liked to in order to facilitate precise reference At the same time, they should be as economical as possible without giving rise to homonymy Terms should be lexically systematic and should conform to the phonological and morphological rules of the language

Terms must conform to the general rules of word-formation of the language or they should allow composition and derivation where appropriate

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Those are advices from International Organization for Standard (ISO 1995) (cited in Bac, N.T, 2003)

I.2.English single words and compounds in comparison with the Vietnamese ones

Single and compound words in Vietnamese have been defined by many established linguists Chau, D.H (1981:40) defines single words as one-morpheme words He also claims that the majority of Vietnamized single words are monosyllabic The number of polysyllabic simple words such as bù nhìn (scarecrow), éch wong (frog), mồ hôi (sweat) is relatively small According to Cần, N.T (1999: 51), a Vietnamese syllable, in most cases, corresponds to a word, whereas compounds are comprised of at least two words that normally can exist independently and seperately from each other

Nguyen Hiet Chi and Le Thuoc (1935) defined that ‘Compound words are words with at least two roots; namely, words in their structures, have at least two morphemes which are not affixationals but root morphemes’

Unlike a Vietnamese single word that is formed by only one morpheme in most normal cases, a single word in English contains at east one morpheme In fact, a single word in English is defined as a sound or a combination of sounds that symbolizes and communicates a meaning and may consist of a single morpheme or of a combination of morphemes (TheFreeDictionary at: www.thefreedictionary.com/ - 74k - Jul 13, 2007) For example, the single word ‘need’ has only one morpheme, but ‘inconceivable’ written as a single word has three morphemes: in, meaning ‘not’, conceive meaning ‘think or imagine’, and able meaning ‘able to be, fit to be’ One important feature of morpheme is that some just have grammatical functions such as making plurality (limitations), and tense (insured)

Compound words in English share certain common features with the Vietnamese ones Take now a definition of compounds as illustration Jackson and Amvela (2000:70) stated that compounds may be defined as stems consisting of more than one roots (cited in Hien, T.T.T, 2005)

1.3 Translation theory 1.3.1 Definition of translation

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claim? And what is translation that is of great importance as implied by Kelly? In an attempt to find the answer to the last question, I have find myself thrown into confusion by quite a few definitions proposed by different linguists Follows are some of them:

According to Cartford (1965), translation is “the replacement of a text in one language (SL) by an equivalent text in another language (TL)” In Bell, R.T (1991:5), the author collected and edited the following definition: “Translation is the expression in another language (or TL) of what has been expressed in another, SL, preserving semantic and stylistic equivalences.” Hatim & Mason (1990:3), however, focus more on the communicative purpose of translation rather than the semantic and stylistic features: “Translation is a communicative process which takes place within a social context’ Newmark (1995:5) simply defines translation as the rendering of a written text into another language in the way the author intended in the text.”

Though put different, these definitions share one common thing, which is to find equivalents that best or appropriately preserve features of the original in terms of semantics, grammatical structures, lexis, cultural context as well as communication situation among other things to be considered

1.3.2 Translation equivalence

Equivalence has been put in the heart of almost all the theories about translation Hence, it is understandable that a great attempt has been made by several linguists in defining equivalence or translation in terms of equivalence as Pym (1992, cited in Baker, 1998) who has pointed to its circularity: equivalence is supposed to define translation, in turn, defines equivalence A close look at different approaches to the question of equivalence will help further illustrate the point:

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In the view of Koller (1979), there are five types of equivalence:

Denotative equivalence: the SL and the TL words refer to the same thing in the real world

Connotative equivalence: this type of equivalence provides additional values besides denotative value and is achieved by the translator’s choice of synonymous words or expressions

Text-normative equivalence: The SL and the TL words are used in the same or similar context in their respective languages

Pragmatic equivalence: With readership orientation, the SL and TL words have the same effect on their respective readers

Formal equivalence: This type of equivalence produces an analogy of form in the translation by their exploiting formal possibilities of TL, or creating new forms in TL

Kade (1968) and other writers on lexical equivalence, in particular in the area of terminology, categorizes equivalence relationships as follows:

One-to-one: There is a single expression in the TL for a single expression in the SL

One-to-many: There is more than one expression in the TL for a single SL one

Many-to-one: There is more than one expression in the SL, but there is only a single expression in the TL that is equivalent to them

Many-to-many: There is more than one expression in the SL and they are equivalent to more than one in TL

Whole-to-part/Part-to-whole: A TL expression is only equivalent to part of the concept designated by a single expression in the SL, or the equivalent in the TL has a broader meaning than the concept in the SL

One-to-zero: There is no expression in the TL for a single expression in the SL

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1.3.3 Translation methods, strategies and procedures

Due to time constraint and within the framework of the thesis, we will present only translation methods, procedures and strategies that match the content of the study, or can serve as a firm foundation for the research

1.3.3.1 Literal translation

It would be useful to study word-for-word translation before having a look at what literal translation is Word-for-word translation, according to Newmark (1995:69), transfers SL grammar and word order, as well as the primary meanings of all the SL words into the translation.” This translation is supposed to be effective only for brief simple neutral sentence Literal translation ranges from one word to one word (hall-salle) through group to group (a beautiful garden-un beau jardin), collocation to collocation (make a speech-faire un discour), clause to clause (when that was done-quand cela fut fait) to sentence to sentence (The man is in the street-L’homme e’tait dans la rue)

1.3.3.2 Communicative translation

Communicative translation attempts to render the exact contextual meaning of the original in such a way that both content and language are readily acceptable and comprehensible to the readership Newmark (1995: 42) claims that in communicative translation, the translator has the right to correct or improve the logic; to replace clumsy with elegant, or at least functional, syntactic structure; to remove obscurities; to eliminate repetition and tautology; to exclude the less likely; to exclude the less likely interpretation of an ambiguity; to modify and clarify jargon, and to normalize bizarreries of idiolect, ie wayward uses of language Further, one has the right to correct mistakes of fact and slips, normally stating what one has done in a footnote

1.3.3.3 Transference

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private companies and institutions, public or nationalized institutions; street names, addresses, etc

1.3.3.4 Shifts or transpositions

A ‘shift’ (Catford’s term) or ‘transposition’ (Vinay and Darbelnet) is a translation procedure involving a change in the grammar from SL to TL Newmark (1995:85) mentions four sub-types of shifts: (1) the change from singular to plural or in the position of the adjective; (2) the change when a SL grammatical structure does not exist in the TL (3) the change where literal translation is grammatically possible but may not accord with natural usage in the TL; (4) the replacement of a virtual lexical gap by a grammatical structure

1.3.3.5 Paraphrase

This is an amplification or explanation of the meaning of a segment of the text According to Baker (1992; 40), the main advantage of the paraphrase is that it achieves a high level of precision in specifying propositional meaning

1.3.4 Technical translation

Newmark (1995:151), in an attempt to distinguish technical translation from institutional translation, claims that technical translation is one part of specialized translation, potentially non-cultural, therefore, universal

According to Sofer (1991, cited in Mai, N, 2003), the translation of a text may be called technical when it requires specialized terms in a particular field

A close look at the two definitions can help identify that though put differently, technical translation is viewed as specialized translation by both two linguists Newmark (1995: 152) go even further, suggesting that there are three varieties or levels of technical language: (1) academic style associated with academic papers, (2) professional style which refers to formal terms used by experts and (3) the popular one including familiar alternative terms

1.4 Translation of terminology I 4.1 Definition of neologisms

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meaning and can therefore be translated out of context, but many of them soon acquire new meanings in the target language

Newmark (1995:141) proposes twelve types of neologism (Old words with new senses; New coinages; Derived words; Abbreviations; Collocations; Eponyms; Phrasal words; Trasferred words; Acronyms; Pseudo-neologisms; and The creation of neologisms) and the way to deal with each but only the ones relevant to the study are presented below:

I 4.2 The translation of neologisms I 4.2.1 Old words with new senses

Old words with new senses, as claimed by Newmark (1995: 141), do not normally refer to new objects and processes, hence non-cultural and non-technical They are usually translated either by a word that already exists in the TL, or by a brief functional or descriptive terms, say, “HI plans-chiwong trình BHYT” or “premium-phí BH”

Existing collocations with new senses may be cultural or non-cultural; if the concept or object exists in the TL, there is usually a recognized translation or through translation If the concept does not exist or the TL speakers are not aware of it, an economical descriptive equivalent has to be given ‘Reimbursement account’ proves itself a good an example

I 4.2.2 Collocations

Newmark (1995:145-146) claims that new collocations (noun compounds or adjectives plus nouns) are particularly common in social sciences Collocations or terms in insurance such as ‘co-pay plan’, ‘Medical spending account’, or ‘Deductible plan’ can serve as a good example These terms represent problems as some of them like ‘Consumer PPO plan’ do not exist in TL And in such cases, what a translator is expected to do is to transfer them and then add a functional-descriptive term Otherwise, we might create our own neologisms, but it is not as easy as it sounds

I 4.2.3 Acronyms

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more, there are many cultural reasons why the acronym may or may not be worth transferring (depending on the standard contextual factors as readership, translation prospects ) In science the letters are occasionally joined up and become internationalisms (‘laser’, ‘master’), requiring analysis only for less educated TL readership In translation, the importance of the acronyms decides on the way they are translated It can be transferred if they stand for institutions or names of companies When a political or social organization become important, it is common to transfer its acronym and translate its name A standard equivalent term, or a descriptive term if the standard does not yet exist

1.5 Chapter conclusion

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CHAPTER II

THE TRANSLATION OF HEALTH INSURANCE TERMS OF EQUIVALENCE GROUP

II.1 An overview of equivalence relationships in the translation of HI terms From the collected data we can group equivalence relationships into four categories, excluding the one-to-zero which will be studied in chapter III: e one-to-one equivalence © one-to-many equivalence many-to-many equivalence e many-to-one equivalence The four following tables present some typical examples of each type: One-to-one equivalence Utilization review đánh giá mức độ sử dung Utilization management quản lý sử dung Exclusion điều khoản loại trừ Renewability tính tái tục Dependent người phụ thuộc One-to-many equivalence

Group health plan BHSK theo nhom

Chương trình sức khỏe chung Tổ hợp BHYT lớn Preexisting Condition Bệnh tật sẵn có Tình trạng sức khỏe trước khi mua BH Deductible Mức miễn thường Khoản khâu trừ Underinsured Được BH (thiêudưới mức/mua với mức thấp) Many-to-one equivalence Hospitalization Insurance

Hospital expense coverage Hospital confinement indemnity

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Many-to-many equivalence

Qualified impairment health insurance BH những người tàn tật được công Special class health insurance nhận đủ tiêu chuân

Substandard health insurance BH tình trạng suy nhược được chấp nhận

BHSK dưới mức tiêu chuẩn

Impaired risk rủi ro đưới mức chuẩn

Substandard risk rủi ro xấu

The variety of equivalence realtionships can be attributed to the following factors: ) There is, to a more a lesser extent, some overlapped area between the US

and Vietnamese insurance as a result of Vietnam’s insurance adapted from the US one

ii) The various sources from which the data was collected

1 BlueCross BlueShield at: www.southcarolinablues.com/bebs/blue_glossary.nsf/ glossary 2 United Healthcare-Trung Tam Tai Nguyén at: www.uhcasian.com/Vietnamese/guests/G_4_4 6.htm 3 HIresource center at: www healthinsurance.org/insterms.lasso 4 SHIBA HelpLine English-Vietnamese Glossary at www insurance wa.gov/publications/consumer/vietnamese/Vietnamese_SHIBA_ Glossary.pdf - Supplemental Result

5 improvement and better insurance at:

www.pjico.com.vn/webplus/attachments/22 ecf7c0260e8cf54e27b353 1 fb86963- Voca-I1.doc - Supplemental Result

6 Thuat ngit BH nhan tho I-Glosary I at: www.baoviet.com.vn

7 Vietnam Insurance Training Center 8 Aon-care Vietnam Resource Center 9 Prudential Vietnam Resource Center

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“3

Vietnamese as “tinh cé thé lam moi” or ‘kha nang cé thé lam mdi’, it seems to be quite reasonable However, it is not an appropriate equivalent and sounds like an explanation rather than a translation, hence less technical and succinct than ‘tinh tai tuc’

Another confusing problem arises when there exist two or more competing terms for the same concept in the Vietnamese version The one-to-many equivalence relationship serves as a vivid illustration The translator has to struggle for a smart choice among all the Vietnamese equivalents available to gurantee the comprehensibility of the translated version for a particular readership Let’s take ‘deductible’-the amount of loss that the insured pays before the insurance kicks in- as an example of the problem It has two Vietnamese equivalents as “ức miễn thường” and “khoản khấu trừ” The former is a commonly used term among insurance circle in Vietnam, whereas the latter is used in Vietnamese community in the US According to a native American experienced translator, if ‘mirc mién thong’ were used in translated versions for the readership there, it would be almost incomprehensible though it is accurate and sounds more professional Clearly, the readership plays a decisive role in the translator’s choice of equivalents since what is preferred by him may not be understandable to the intended readers

As far as ‘many-to-one’ equivalence relationship is concerned, it poses no problem to translators in the sense that the context in which the term is used can give the translator a hint to figure out its meaning And it appears that among more than one terms referring to a same concept in the SL, there must be one which is more widely used than others The likelihood of encountering a completely new term used to express a common concept, therefore, may be minimized For example, ‘participant’ (nguoi tham gia BH) is more universally used than ‘subscriber’ and ‘enrollee’, with the latter making sense only in the US sub-culture of insurance

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tiéu chudn’ respectively The former is highly recommended in the US for Vietnamese- American whose level of education in not high and the latter for the opposite group In Vietnam, both are used equally Again, the importance of the readership to the choice of lexical word is undeniable, requiring the translator to firstly characterize the readership of the TL before working on the text

From scratch, the researcher assumed that there would be more than one equivalence relationships since the data was collected from different sources in Vietnam and in the US where both American-American and Vietnamese American translators work with insurance documents Expectedly, however, all the translators employ common translation strategies and procedures when dealing with HI terms in the US health plans, which will be studied after we have investigated the structural patterns of these terms II.2 Classification of HI terms in the US health insurance plans according to their structural patterns

HI terms are divided into two sub-groups according to their structural features: single terms and compound terms

11.2.1 Single terms

II.2.1.1 Single terms in the form of a noun

The terms that are nouns (also including those deriving from verbs) can be divided into subgroups as follows:

Sub-insurance terms

A fairly big number of HI terms collected for this study are ordinary words that lose their normal sense and take on the specialist meaning, e.g., the normal sense of ‘policy’ is ‘a set of ideas or plans that is used as basis for making decisions, especially in politics, economics or business’ (chinh sach) Its specialist meaning is a document which shows the agreement that you have made with an insurance company (don BH) Right below are other examples:

English terms Vietnamese terms

participant người tham gia/mua BH

exclusions điều khoản loại trừ

rider điều khoản riêng loa trừ

representation lời khai của người được BH

limitations điều khoản hạn chế

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These terms can create difficulties for translators because words commonly met in general English take on a specialized meaning within, say, insurance context Although the user already knows the general meaning, he may be thrown into confusion when coming across it in a context with a totally different meaning he has never experienced before High-insurance terms

It is commonly known that every subject has its set of highly technical terms, which is an intrinsic part of the learning of the discipline itself Without background knowledge of the field, it would be hard for the user to understand these terms

Followings are good examples of high-insurance terms:

coinsurance BH phụ/đồng BH

underwriting việc xét nhận rủi ro y tế

co-payment đồng trả/cùng trả tiền

formulary thuốc khuyến cáo

reimbursement sự bồi hoàn

If equipped with little knowledge of both English language and HI in Vietnam and the US, the user will definitely find these terms really hard-to-crack

II.2.1.2 Single terms in the form of an adjective

Unlike technical terms in the form of a verb, almost all the terms in the form of an adjective do not have their nouns to be used as alternatives

eligible hội đủ điều kiện

usual thông thường

reasonable vừa phải

guaranteed được đảm bảo

underinsured BH dưới mức

uninsured không được BH

One important feature of these adjectives is that all of them usually collate with one or two certain nouns to form collocations:

eligible employees/dependents ( người phụ thuộc/nhân viên hội đủ điều kiện) usual/customary/reasonable fees (phí thông thường/thông dụng/vừa phải ) guaranteed issue (quyền lợi được BH)

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We have examined single HI terms that account for significant proportion of the total collected terms

I[.2.2 Compound terms

These are terms which are composed of two words or more; these words, which are of different part of speech, combine and create terms that have the form of nominal group (Halliday’s term)

II.2.2.1 The nominal group

It would be insufficient not to study the experiential structure of the nominal group, so the following section will focus on such a brief investigation

According to Halliday (1985: 180), the nominal group structure comprises the Thing, commonly called head noun, preceded by various items including Deictic, Numerative, Epithet, Classifier, and followed by Qualifier The following table will exactly illustrate the structure: Deictic Numerative | Epithet Epithet | Classifier | Thing Qualifier Those two splendid old electric , trains with pantographs

All the items functioning as pre-modifier and post-modifier will be briefly presented in the following table:

Item Function Example

Deictic The Deictic element indicates whether or () This, these, my not some specific subset of the Thing is (ii) A, each, every intended It is either (i) specific or (ii) non-

specific

Numerative | The Numerative element indicates some (i) one, two

numerical feature of the subset : either (i) (ii) first, second, few, quantity or (ii) order, either exact or inexact little, many Epithet | This item, usually in the form of an () old, short, heavy

adjective, indicates some quality of the (ii) wonderful, subset This can be (i) an objective property splendid, silly of the thing itself; or (ii) it may be an

expression of the speaker’s subjective attitude towards it

Classifier | The Classifier indicates a particular subclass () medical insurance of the thing in question It can be (i) an (ii) health insurance,

adjective or (ii) a noun drug coverage

Thing The Thing is the semantic core of the nominal group, which may be common noun, proper noun, or personal noun

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characterizes it It can be a relative clause or | reimbursed to the insured a prepositional phrase person

As far as Classifier is concerned, it needs more detailed discussion since apart from adjectives and nouns which serve as classifiers; verbs also enter into the nominal group, functioning as Epithet or Classifier in one of the two forms:

(i) present (active) participle, V-ing, e.g participating, as in participating physician (ii) past (passive, or intransitive active) participle, V-en, e.g insured, as in insured employee or covered in covered expense

When serving as Epithet, these forms usually have the sense of the finite tense to which they are most closely related: the present participle means ‘which is (was/will be) ing’, the past participle means ‘which has (had/will have) been ed’

Examples:

a prevailing phenomena ( a phenomena which is prevailing) two satisfied customers (two customers who have been satisfied)

When these forms function as Classifier, they typically have the sense of a simple present, active or passive: present (active) ‘which s’, past (passive) ‘which ed’

Examples:

qualifying period (period that qualifies)) expected morbidity (morbidity that is expected)

Often the participle itself further modified, as in self-funding employer, pre- existing condition, state-mandated benefits, tax-advantaged account

Sometimes, the same word may function either as Epithet or as Classifier, with different meaning Let’s look at ‘fas?’ in ‘fast trains’ ‘Fast’ serves as Epithet in the sense that it means ‘trains that go fast’, and functions as Classifier since it classifies a subtype of train, that is ‘express train’

It is noted that usually several classifiers cluster around a thing to indicate subclasses of more concreteness Nouns, adjectives, participles, positioned near the Thing, are most common classifiers in English

Examples:

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If.2.2.2 Health insurance terms in the US health plans in the form of the nominal group

A number of high-frequency nominal groups have been found among terms collected for this study

II.2.2.2.1 Terms consisting of Classifier (noun) +Thing

As implied by the name, these terms consists of two nouns with the first one functioning as Classifier It distinguishes the Thing (the second noun) from other concept of the same group For example, health in ‘health insurance’ (BHSK) helps distinguishes this type of insurance from many other types such as ‘disability insurance’ (BH thuong tat), ‘car insurance’ (BH xe 6 t6), ‘home insurance’ (BH nhà 0) Other examples of this group:

health exposure (rui ro về sức khỏe)

network provider (nhà cung cấp thuộc mạng lưới)

fee schedule (giá biểu liệt kê các mức thanh toán tối đa)

indemnity plan (dich vu tinh tién) benefit period (thoi ky thu huong)

II.2.2.2.2 Terms consisting of Classifier (adjective) +Thing

A term in this group is formed by an adjective that serves as Classifier and the Thing

Examples:

creditable coverage (viéc duge BH chính đáng) customary fee (phi thong dung)

dental coverage (BH rang)

supplemental insurance (chuong trinh BH phu/bé sung) eligible employees (nhan viên hội đủ điều kiện)

The Classifier, as discussed in (II.2.2.1), can be further modified by another sub- classifier that takes on the form of a noun or an adjective:

basic health plan (chuong trinh BHSK co ban) group health plan (BHSK theo nhom)

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And several classifiers cluster around a Thing to indicate subclasses of more concreteness like the followings:

qualified impairment HI (BH ngudi tan tật được công nhận đủ tiêu chuẩn) special class HI (BH tình trạng suy nhược được chấp nhận)

prepaid group practice package (BH trọn gói chỉ phí y tế tập thể trả trước) II.2.2.2.3 Terms consisting of Classifier/Epithet (present participle) +Thing

In this group, some V-ing function as (i) Epithet and some as (ii) Classifier : () If you do not go to participating physician, you may get lower level of

coverage

(ii) Eliminating this two-year waiting period would provide stable HI to a vulnerable group of adults who are unable to work

However, when interpreted in different situations, some others can be either Classifier or Epithet:

self-funding employer (BH của hãng cho nhân viên) pre-existing condition (bệnh tật có sẵn)

II.2.2.2.4 Terms consisting of Classifier/Epithet (past participle) +Thing

Like V-ing participle, some V-ed ones can serve as either Classifier or Epithet, and what function it carries depends on different situations:

covered expense (chi phi duge bao tra) insured person (người được BH) impaired risk (rủi ro xấu)

experienced morbidity (tỷ lệ bệnh tật theo kinh nghiệm) II.2.2.2.5 Terms consisting of Thỉng + Qualifier

The Qualifier in this group is usually ‘of noun phrases’:

evidence of insurability (bang chứng về khả năng có thể BH)

coordination of benefits (phối hợp quyền lợi)

schedule of benefits (bảng liệt kê các quyền lợi được hưởng) certificate of insurance( giấy chứng nhận BH)

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groups Single terms are further grouped into sub-insurance terms and high insurance terms There are subgroups of terms under the head ‘compound terms’

The next part will focus on what translation strategies and procedures have been used currently to translate HI terms that do not belong to non-equivalence group, and then draw out the ones that may be best applicable

I1.3 The common strategies and procedures used in the translation of HIterms of equivalence group

II.3.1 The translation of single terms — Old words with new senses

The number of HI single-terms in English, both low-insurance and high-insurance ones, takes up a fairly significant proportion in comparison with compound terms They, therefore, create a certain level of difficulty to translators Almost all the terms in this section can be grouped under the heading “Old words with new senses” They already exist in the language and are commonly used with their basic nuclear meaning However, onced used in a professional narrow scale, these terms acquire new typical meaning of the field as analysed with vivid examples in (II.2.1)

What should be noted here is that with regard to equivalence in form, not all Vietnamese terms can be seen as the equivalents for the single terms in English in quite a few cases The discernible difference can be detected with ease Take now the single term ‘representation’ It is clearly a term in the form of a single word When it is rendered into Vietnamese as “lời khai của người được BH, ït is no longer a single word Rather, it is a noun phrase and has the form of ‘head noun (loi khai) + of (ctia) + postmodifier (ngudi duoc BH)’ The other two examples help further illustrate the non-equivalence problem in forms They are ‘coinsurance’ and ‘formulary’ that take ‘déng BH’ and “thuốc khuyến cáo" respectively as their Vetnamese equivalents In these cases, the Vietnamese terms are not single words, but compounds as defined by Can, N.T (1999: 49) Even, the sinlge term ‘underwriting’ has its Vietnamese equivalent “việc nhận xét rủi ro y té’ in the form of a free group of words as defined by Nguyen Nhu Y (1996:64) Such a group is comtemporarily made to meet the need of the reality to be described or to meet the subjective demand of the speaker or the writer

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I[.3.2 The translation of compound terms by rank shift or transposition

The translation of the following groups of terms involves a change in the grammar

from SL to TL, which is the so-called transposition or a shift

Group 1: Terms translated with transposition procedure that involves an automatic change in the word order from SL to TL

Since this is the only translation procedure concerned with grammar, most translators make transposition intuitively Specifically, what they have to do with the terms in this group is the change in the position of adjectives or modifying elements due to the difference in word order between English and Vietnamese Van (1998) claims that English nominal group differs from the Vietnamese one in terms of the order of Classifiers and Epithets in relation with the Thing, and this is presented in the table below: English Vietnamese Classifier/Epithet + Thing Thing + Classifier/Epithet

Examples of terms translated by this procedure are as follows: Classifier (noun) +Thing English terms benefit period utilization management cost containment sub-standard risk health insurance Classifier/Epithet (adjective) +Thing medical insurance dental insurance common fee major plan supplemental plan Vietnamese terms thời kỳ thụ hưởng quản lý sử dụng kiểm soát chỉ phí rủi ro dưới mức tiêu chuẩn BHSK BH ytế BH nha khoa/răng chi phí thông thường chương trình chính chương trình phụ/bố sung

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corresponding word order in Vietnamese Terms of longer nominal group, within expectation, can also be easily dealt with this way:

English word order Vietnamese word order

medical benefits exemption miễn trừ các quyền lợi y tế

group health plan chương trình BHSK theo nhóm

hospital expense coverage BH chỉ phí nằm viện dental expense coverage BH chi phi nha khoa Individual health insurance BHSK ca nhan

This type of transposition can be of great help in that it is applicable to the translation of nominal groups of different types, especially longer groups as follows:

English word order Vietnamese word order

guaranteed renewable health insurance BHSK tái gia hạn được bảo đảm conditional renewable HI BHSK tái tục có điều kiện major medical expense coverage BH chỉ phí y tế chính

creditable drug prescription coverage BH theo đơn thuốc chính đáng (See more examples in Appendix 2)

The Vietnamese equivalents that sound stiff or fail to accord with natural usage in Vietnamese are categorized under the heading “Literal translation” which will be touched upon in the “non-equivalence” section

Group 2: Terms consisting of Classifier (past participle) + Thing

Exactly, the terms in this group can be translated by either (i) automatic transposition or (ii) by rank-shift that involves a change in grammatical structure of certain items in SL To be more specific, a nominal group in English corresponds to a clause in Vietnamese as follows:

(i) expected morbidity = sé liéu thong kê bệnh tật dự tính

A change in the position of V-ed acting as Classifier is needed so that the Vietnamese version can sound natural and accords to the word order in the Vietnamese nominal group

(ii) expected morbidity = số liệu thống kê bệnh tật (đã) được dự tính

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economy of the text, and it sounds more technical and succinct, the longer one still gets the priority for the comprehensibility of the version in Vietnamese:

Other examples:

English terms Vietnamese terms

uncovered expense các chi phí không được bao trả standardized plans các chương trình đã được chuân hoá

insured employees nhân viên đã được BH

uncompensated care dịch vụ chăm sóc không được bồi thường (See more examples in Appendix 3)

IL.3 3 The translation strategy which involves the deletion of “OF”

Group 3: Terms consisting of Thing + Qualifier (noun + of +noun/noun phrase) Within this study, we have collected 13 nominal groups in the form of ‘Thing + Qualifier (of phrase)’ If, when rendering these terms into Vietnamese, we translate the preposition ‘of as ‘cla’, the version in Vietnamese will not sound naturally as the way it should normally be Put differently, it definitely fails to accord with the natural usage in Vietnamese:

evidence of insurability bằng chứng của khả năng có thể BH schedule of benefits bảng liệt kê của các quyền lợi được hưởng

If such translation is seen in the light of literal translation, it is grammatically acceptable However, a translation is not simply the converting of grammatical elements from SL in to TL The translator, among many other things to take into consideration when doing his job, has to decide when and what to add or omit to make the translated version readable and natural

Concerning the translation of the terms in this group, the deletion of “of” is widely made, yielding such equivalents as follows:

English terms Vietnamese terms

duplication of benefits kết hợp quyền lợi

summary of plan bản tóm tắt chương trình BH

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In so doing, the translators can avoid lengthy expression which may, to some extent, distract readers One noteworthy thing here is that this translation strategy should only be employed only when the advantages of producing smooth translation clearly overweigh the value of exactly rendering a certain meaning in a given context

11.4 Concluding remarks

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CHAPTER III THE TRANSLATION OF HEALTH INSURACNE TERMS OF NON- EQUIVALENCE GROUP Examples of nil equivalence: Non-equivalence or One-to-zero equivalence

employee +1 and more coverage BH nhân viên +1 tro lén

community rating đánh giá cộng đông

gatekeeper bác sĩ HMO điêu hợp chăm sóc bệnh

nhân và kiểm soát hiệu quả chỉ phí băng cách giảm thiêu dịch vụ không cân thiệt HMO (Health Maintenance Organization) | BH HMO

Medicaid chuong trinh Medicaid

III.1 The source of non-equivalence problem in the translation of HI terms Though it is a luxury for a translator to say that something cannot be translated, there are exceptions for a number of reasons as Mona Baker (1992) shows in her famous book titled ‘In other words-A course book on translation’:

Culture-specific concepts

The SL concept is not lexicalized in the TL The SL is semantically complex

The SL and TL make different distinctions in meaning The TL lacks a superordinate

The TL lacks a specific term Differences in expressive meaning Differences in forms

Differences in frequency and purpose of using specific forms The use of loan words in the source text

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The development of the US HI dates back to 1907, whereas Bao Viét-the oldest insurance carrier in Vietnam, offering all kinds of insurance including health insurance- has been in operation for just only as long as 40 years, 60 years younger than the US counterpart A big gap in the development of the sub-culture of insurance between the two countries is, therefore, inevitable

More noticeably, the US is the only industrialized nation that did not choose the compulsory HI path, whereas in Vietnam employees working in legally operated establishments are offered with only one type of compulsory health plan Put differently, American employees enjoy full freedom in choosing to enroll in the health plan which best suit their needs and income Once a year, employers hold an open enrolment for their employees to choose to stay with the plan they enrolled the year before or to switch to another They are well informed or updated about any changes in health plan thanks to the information provided directly to their home by the employer By contrast, employees in Vietnam, especially workers, have no idea about to what extent they are covered Regarding the type of coverage, only state-mandated medical insurance is available

Another sharp difference is that our government has no coverage for the low- income or people over 65 years who did not work in the past as in the US In fact, the US government designs specific health plans for specific people in an attempt to guarantee that everyone is covered Vietnam is too poor to do so and that is the very reason why there are many health plans in the US we have never heard about

In a nutshell, the differences in the level of the development of HI between the US and Vietnam, and the diversity of health plans in the former are the source of non- equivalence problem in the translation of HI terms in the US health plans The following section will focus on the analysis of how the problem is currently handled

HIH.2 The strategies, procedures and methods employed in dealing with non- equivalence problem in the translation of HI terms

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Group 4: HI acronyms

These acronyms are created and used for the purpose of one text to designate products, appliances, processes and international institutions within the particular text In translation, they can be either decoded or transferred: if they appear for the first time they are usually accompanied by both English (in case readers know English, they themselves can figure out their real essence) and Vietnamese full forms; and if they are repeated or used at other points in the target language text, the full forms are withdrawn Source language acronyms are often retained for convenience and to avoid repeatability Example 1: First time: Source language: Members have to choose a primary care physician (PCP), who becomes the personal doctor Target language:

Những người tham gia BH phải chon mot bade sĩ chăm séc chinh (primary care physician _PCP) Người đó sẽ trở thành bác sĩ riêng của họ

Second time forward: Source language:

No matter what health problem you encounter, it is required that you always call your PCP first and

Target language:

Cho dù quý vị gap van đề gì về sức khỏe, việc đầu tiên quý vị phải làm là liên lạc với PCP của quý vị và

The second example can better illustrate the convenience of using of acronyms in the translated version:

Source language:

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Target language:

Chương trình BH của Tổ chức cung cấp dịch vụ ưu đãi (Preferred Provider Organization-PPO) (1) két hgp các quyền lợi của chương trình dịch vụ tính tiền với các quyền lợi của chương trình HMO Nếu bệnh nhân sử dụng dịch vụ của các nhà cung cấp chăm sóc sức khỏe thuộc mạng lưới PPO (2) .Một số PPO (3) yêu cầu mọi người chọn một bác sĩ chịu trách nhiệm chính cho mình Các PPO (4) khác cho phép các bệnh nhân tự chọn bác sĩ của mình ngoài mạng lưới Các bệnh nhân sử dụng các dịch vụ của các bác sĩ hoặc chuyên gia không thuộc mạng lưới của PPO (5) sẽ được PPO (6) bao trả với mức

thấp hơn

(See more examples in Appendix 5) Even at a glance, one can recognize that the translated version would be more than clumsy if the borrowed foreign acronyms are not made use of In fact, they are more and more frequently used by translators as an effective strategy to deal with this type of non- equivalence problem arising from the gap in the subculture of insurance

What should be noted is that acronyms collected in this study such as HMO, PPO, POS and EPO stand for the names of organizations which do no exist in Vietnam, hence completely unknown to Vietnamese speakers So far, no direct equivalents have been found, and we find that all of these terms are translated rather literally with the lexical rendered out of context Their names, when translated into Vietnamese, can not themselves tell readers about their functions The translation, however, would be lengthy or cumbersome if an explanation is provided in parentheses In an attempt to facilitate readers’ thorough understanding about different insurance plans so that they have made right decision at annual open enrolment, a glossary in the target language is added by translators to facilitate enrollees’ understanding about different health plans This helps lead to their sound decisions at annual enrollment

Group 5: Terms referring to the name of health plans unavailable in the subculture of insurance in Vietnam

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Table 1: Terms referring to the name of health plans

English terms Vietnamese equivalents

Medicaid plan Chuong trinh Medicaid (loai hinh BH danh cho người nghèo)

Medicare plan Chuong trinh Medicare (loai hinh BH danh

cho người trên 65 tuổi)

Medi-gap plan Chương trình Medi-gap (chương trình bao trả các chi phí vượt quá mức bao trả của chương trình Medicare)

Medicare Advantage plan Chương trình Medicare Advantage (chương trình cho phép người thụ hưởng được lựa chọn các nhà cung cấp dịch vụ y tế ngoài Medicare)

Medicare Specialty plan Chương trình Medicare Spccialty (loại hình BH dành cho các đôi tượng có bệnh lý đặc biệt)

Spend-down plan Chương trình Spend-down (dành cho những người có thu nhập bị giảm hoặc thất thoát về tài sản)

To compensate for the untranslatability, some translators add a finctional- descriptive equivalent in parentheses as shown in Table 1 This is of great help for those who are not good at English; otherwise, the intended readers will definitely find it impossible to understand what, say, “Spend-down plan” is If the name of a plan appears at other points in the text, the functional-descriptive equivalents will be withdrawn since readers have presumably got hold of the concerned perception

III.2.2 The translation of terms by paraphrase

Paraphrase has been employed by both professional and amateur translators in all fields either consciously or unconsciously, though as a last resort in many contexts This is simply an explanation of the meaning of the source item(s) In the following section, we will investigate how a number of HI terms are translated by paraphrase

Group 6: Terms referring to culture-specific concepts

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have to paraphrase them, using either related words or unrelated words to unpack the meaning of the terms in question Here are some typical examples:

Table 2: Terms translated by paraphrase

English terms Vietnamese equivalents

donut hole giai doan 3 trong chuong trinh Medicare ma

theo quy định thì người tham gia BH phải ty trả các chỉ fi y tê

self-finded plan BH bao trả theo chi fi y tế thực của hãng cho nhân viên thông qua quỹ được đóng góp theo tỷ lệ phần trăm nhất định giữa chủ hãng và nhân viên

staff model mô hình HMO cho cá nhân

accrete bổ sung thêm thành viên mới vào chương

trình BH trợ câp y tÊ Medicare của chính phủ dành cho người trên 6Š tuôi

delete loại ra khỏi diện được BH bởi chương trình

BH trợ câp y tê Medicare của chính phủ dành cho người trên 65 tuôi

No-gap [Bác sĩ] cam kết không tính phí cao hơn

mức thanh toán tối đa của BH cho một dịch vụ nào đó

Known-gap [Bác sĩ] tính phí cao hơn mức thanh toán tối đa của BH nhưng cam kết giữ số chênh lệch này trong một phạm vi quy định

(See more examples in Appendix 7) Clearly, from Table 2, all the seven terms are explained or paraphrased rather than being translated The reasons why translators have to resort to this strategy are easily isolated, that is the unavailability of the Vietnamese equivalents and the subculture-sourced concepts unknown in Vietnamese “Self-funded plan” can serve as a very good example of , the latter Unlike Vietnam where all employers pay a fixed premium to an insurance carrier, in the US, several employers set up a special trust fund to earmark money (corporate and employee contribution) to pay incurred claims Probably, only by explaining the term can translators be sure that the intended meaning of the term is fully conveyed to the intended readers

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Nevertheless, this strategy reveals in itself two disadvantages Firstly, a paraphrase does not have the status of a stable lexical item, hence failing to transfer its associated expressive, evoked, or any kind of associative meaning into the target language Secondly, when one term in the source language is replaced by a lengthy explanation in the target v cfeuydlanguage it is undoubtedly cumbersome and even awkward

III.2.3 The translation of terms with communicative method

Within this research, the researchers find that the translators go for communicative method for a generous transfer of foreign elements in to the target culture as well as the target language where necessary

Group 7: Terms referring to culture-specific concepts

In (IIL.2.2), we have studied how terms referring to culture-specific concepts are dealt with by paraphrase Seemingly, such terms have been best translated by the procedure or strategy of paraphrase because of the non-equivalence problem analyzed in the above section However, there are terms which also refer to culture-specific concepts, but solved with communicative method rather than by paraphrase To some or many extent, the translators who employ the strategy do get profound knowledge of the sub- culture of insurance in both the two countries This can be manifested by the way they handle the terms and choose the lexical words in Vietnamese The contextual meaning of the terms is rendered in such a way that both content and language are readily acceptable and comprehensible to the intended readers Examples: Table 3: Terms translated with communicative method

English Vietnamese equivalents

cafeteria plan chương trình BHSK tự chọn

fee-for-service/indemnity plan tiền trao cháo múc

dịch vụ tính tiền

wellness office visit kham dinh ky

office visit dén kham bénh tai phong mach

triage sang loc cac bénh nhan can wu tién

fee schedule giá biêu liệt kê các mức thanh toán tối đa well-baby care săn sóc phòng bệnh cho trẻ nhỏ

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