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Crippling health care bills, long emergency-room waits and the inability to find a primary care physician just scratch the surfa

admin2017-07-09  34
问题     Crippling 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 backbone 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 (老年医保受惠人). The startling finding was that the average Medicare 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 don’t guarantee better care. Actually, increasing fragmentation of care results in a corresponding rise in cost and medical errors.
    How did we let primary care slip so far? 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(返还费用). 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 indiscriminately 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 are not blind to this scenario. They see how heavily the reimbursement deck is stacked 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 (最佳地) 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?  
Faced with the government threats to cut reimbursements indiscriminately, primary care physicians have to_________.
选项 A、see more patients at the expense of quality
B、improve their expertise and service
C、make various deals with specialists
D、increase their income by working overtime
答案A
解析 细节题。根据题干中的government threats to cut reimbursements indiscriminately将本题出处定位到第四段末句。this fact即上句的专科医生普科医生同工时却不同酬。no choice but to后提到在政府将不加区分地减少返还给医生的报酬这一坏兆头下，普科医生的唯一选择：increase quantity to boost income，即提高看病数量以增加收入。结合下句提到的有些普科医生拒绝compromise quality(降低质量)可推断，这种“提高看病数量”其实以降低质量为代价的，故A项为正确答案。
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