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  3. The Planning Commission asserts that the needed reduction in acute care hospital beds can best be accomplished by closing the sm

The Planning Commission asserts that the needed reduction in acute care hospital beds can best be accomplished by closing the sm

admin2017-04-21  100
问题     The Planning Commission asserts that the needed reduction in acute care hospital beds can best be accomplished by closing the smaller hospitals, mainly voluntary and proprietary. This strategy follows from the argument that closing entire institutions saves more money than closing the equivalent number of beds scattered throughout the health system.
    The issue is not that simple. Larger hospitals generally are designed to provide more complex care. Routine care at large hospitals costs more than the same care given at smaller hospitals. Therefore, closure of all the small hospitals would commit the city to paying considerably more for in-patient care delivered at acute care hospitals than would be the case with a mixture of large and small institutions. Since reimbursement rates at the large hospitals are now based on total costs, paying the large institutions a lower rate for routine care would simply raise the rates for complex care by a comparable amount. Such a reimbursement rate adjustment might make the charges for each individual case more accurately reflect the actual costs, but there would be no reduction in total costs.
    There is some evidence that giant hospitals are not the most efficient. Service organizations and medical care remains largely a service industry — frequently find that savings of scale have an upper limit. Similarly, the quality of routine care in the very largest hospitals appears to be less than optimum. Also, the concentration of all hospital beds in a few locations may affect the access to care.
    Thus, simply closing the smaller hospitals will not necessarily save money or improve the quality of care.
    Since the fact remains that there are too many acute care hospital beds in the city, the problem is to devise a proper strategy for selecting and urging the closure of the excess beds. However many it may turn out to be.
    The closing of whole buildings within large medical centers has many of the cost advantages of closing the whole of smaller institutions, because the fixed costs can also be reduced in such cases. Unfortunately, many of the separate buildings at medical centers are special-use facilities. The relocation of which is extremely costly. Still a search should be made for such opportunities.
    The current lack of adequate ambulatory care facilities raises another possibility. Some floors or other large compact areas of hospital could be transferred from in-patient to ambulatory uses. Reimbursement of ambulatory services is chaotic, but the problem is being addressed. The overhead associated with the entire hospital should not be charged even pro rate to the ambulatory facilities. Even if it were, the total cost would probably be less than that of building a new facility. Many other issues would also need study, especially the potential overcentralization of ambulatory services.
    The Planning Commission language seems to imply that one reason for closing smaller hospitals is that they are "mainly voluntary and proprietary". Thus, preserving the public hospital system by making the rest of the hospital system absorb the needed cuts. It is important and not hidden behind arguments about hospital size. If indeed that was the meaning.
How does the author feel that his suggestions for closing in-patient beds could impact on the ambulatory care system?
选项 A、A reduction of hospital beds will increase the demand for ambulatory services.
B、Small hospitals will have to cut back ambulatory services to stay fiscally viable.
C、The use as ambulatory facilities of the space made available in large hospitals by bed closings might result in having too many ambulatory services based in large hospitals.
D、Ambulatory care costs will probably reduced.
答案C
解析 本题是作者态度的问题。通读全文可推知作者不赞成关闭小医院，所以在文章结束处作者一定会提出自己的解决办法。
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