Question

    Shortage of Primary Care Threatens Health Care System

Increasing health care bills, long emergency-room waits and the inability to find a primary care physician just scratch the surface of the problems that patients face daily.

Primary care should be the support of any health care system. Countries with appropriate primary care resources score highly when it comes to health outcomes and cost. The U.S. takes the opposite approach by emphasizing the specialist rather than the primary care physician.

A recent study analyzed the providers who treat Medicare beneficiaries. The surprising finding was that the average Medicate patient saw a total of seven doctors - two primary care physicians and five specialists - in a given year.

Contrary to popular belief, the more physicians taking care of you doesn't guarantee better care. Actually, increasing fragmentation of care results in a corresponding rise in cost and medical errors.

How did we take little care of primary care? The key is how doctors are paid. Most physicians are paid whenever they perform a medical service. The more a physician does, regardless of quality or outcome, the better he's reimbursed. Moreover, the amount a physician receives leans heavily toward medical or surgical procedures.

A specialist who performs a procedure in a 30-minute visit can be paid three times more than a primary care physician using that same 30 minutes to discuss a patient's disease. Combine this fact with annual government threats to randomly cut reimbursements, physicians are faced with no choice but to increase quantity to boost income.

Primary care physicians who refuse to compromise quality are either driven out of business or to cash-only practices, further contributing to the decline of primary care.

Medical students aren't blind to this action. They know how heavily the reimbursement is against primary care. The recent numbers show that since 1997, newly graduated U.S. medical students who choose primary care as a career have declined by 50%. This trend results in emergency rooms being overwhelmed with patients without regular doctors.

How do we fix this problem?

It starts with reforming the physician reimbursement system. Remove the pressure for primary care physicians to squeeze in more patients per hour, and reward them for optimally managing their diseases and practicing evidence-based medicine. Make primary care more attractive to medical students by forgiving student loans for those who choose primary care as a career and reconciling the marked difference between specialist and primary care physician salaries.

We’re at a point where primary care is needed more than ever. Within a few years, the first wave of the 76 million Baby Boomers will become eligible for Medicare. Patients older than 85, who need chronic care most, will rise by 50% this decade.

Who will be there to treat them?

1.The author’s chief concern about the current U.S. health care system is _________.

A.the ever-rising health care costs B.the declining number of doctors

C.the inadequate training of physicians D.the shrinking primary care resources

2.We learn from the passage that people tend to believe that _________.

A.the more doctors taking care of a patient, the better

B.visiting doctors on a regular basis ensures good health

C.seeing more doctors may result in more diagnostic errors

D.the more costly the medicine, the more effective the cure.

3.Faced with the government threats to cut reimbursements randomly, primary care physicians have to __________.

A.make various deals with specialists B.improve their expertise and service

C.see more patients at the expense of quality D.increase their income by working overtime

4.What suggestion does the author give in order to provide better health care?

A.Extend primary care to patients with chronic diseases.

B.Recruit more medical students by offering them loans.

C.Reduce the tuition of students who choose primary care as their major.

D.Bridge the salary gap between specialists and primary care physicians.

Answer

1.D

2.A

3.C

4.D

【解析】

这是一篇说明文。文章主要说明了如今美国医疗保健系统的主要问题是基层医疗资源的萎缩，文章分析了这一现象背后的原因以及对此提出了建议。

1.

推理判断题。根据第二段Primary care should be the support of any health care system. Countries with appropriate primary care resources score highly when it comes to health outcomes and cost. The U.S. takes the opposite approach by emphasizing the specialist rather than the primary care physician.可知基层医疗应是任何医疗系统的支持。拥有适当基层医疗资源的国家在卫生结果和费用方面得分很高。美国则采取了相反的做法，强调专科医生而不是基层医疗医生。由此可推知，作者对当前美国医疗保健系统的主要担忧是基层医疗资源的萎缩。故选D。

2.

细节理解题。根据第四段中Contrary to popular belief, the more physicians taking care of you doesn't guarantee better care.可知与普遍的看法相反，照顾你的医生越多，并不能保证更好的护理。由此可知，人们倾向于认为医生照顾病人越多越好。故选A。

3.

细节理解题。根据第五段中Most physicians are paid whenever they perform a medical service. The more a physician does, regardless of quality or outcome, the better he's reimbursed.可知大多数医生在提供医疗服务时都能得到报酬。医生做得越多，不管质量或结果如何，他得到的补偿就越好。结合第六段中Combine this fact with annual government threats to randomly cut reimbursements, physicians are faced with no choice but to increase quantity to boost income.可知再加上政府每年都会威胁要随意削减报销，医生们别无选择，只能通过增加数量来增加收入。以及第七段Primary care physicians who refuse to compromise quality are either driven out of business or to cash-only practices, further contributing to the decline of primary care.可知拒绝降低质量的初级保健医生要么被逐出业务，要么只能从事现金业务，这进一步导致了初级保健的下降。由此可知，面对政府随机削减报销的威胁，基层医疗医生不得不以牺牲质量为代价看更多的病人。故选C。

4.

细节理解题。根据倒数第三段中Make primary care more attractive to medical students by forgiving student loans for those who choose primary care as a career and reconciling the marked difference between specialist and primary care physician salaries.可知通过免除选择基层医疗作为职业的学生的助学贷款，调和专科医生和基层医疗医生工资的显著差异，提高基层医疗对医科学生的吸引力。由此可知，为了提供更好的卫生保健，作者的建议是缩小专科医生和基层医疗医生之间的工资差距。故选D。