首页
外语
计算机
考研
公务员
职业资格
财经
工程
司法
医学
专升本
自考
实用职业技能
登录
外语
Too Much Healthcare A) For people who had been awaiting the rollout of the Affordable Care Act in order to obtain health ins
Too Much Healthcare A) For people who had been awaiting the rollout of the Affordable Care Act in order to obtain health ins
admin
2022-07-18
87
问题
Too Much Healthcare
A) For people who had been awaiting the rollout of the Affordable Care Act in order to obtain health insurance for the first time, the major problem associated with American healthcare has been a lack of access to it. But for a surprising number of Americans, the greater problem may be exactly the opposite: They are receiving too much healthcare. And that’s not good news for either their wallets or their physical well-being.
B) The most recent estimate from the Institute of Medicine is that about 30 percent of total healthcare expenditures in America go toward unneeded care. Doctors, too, have acknowledged the problem: In a 2011 survey published in the Archives of Internal Medicine, 42 percent of American primary care physicians said that patients in their own practice were getting more care than necessary.
C) Excessive care typically takes the form of overabundant referrals (转诊病人) to specialists, more diagnostic tests than would be medically necessary, or too many prescriptions—but in some cases, it can extend to actual treatments or surgeries that are not clinically indicated. Richard Baron, president of the American Board of Internal Medicine, is candid (直言不讳的) about the problem. "There were and are lots of things being done in healthcare that don’t reliably benefit patients," he says.
D) From a patient perspective, it can be hard to see at first glance how too much care could be a problem. But unneeded healthcare can be physically damaging. "Anything we do in medicine and healthcare has expected benefits and harms," says Brenda Sirovich, a research associate at the VA Medical Center in White River Junction, Vermont. "Any time you have an intervention for a patient, no matter how small there is also the chance that it’s going to do some harm."
E) Even for initial screening tests that pose no risk in themselves, there’s the problem of the "downstream effect"; if the first test produces an ambiguous result or a false positive, it can lead to more invasive testing that does carry substantial risk. "As you intervene on patients who have less and less reason to intervene and less and less chance of benefiting, you still retain that probability of harming them," says Sirovich. "In a word, that is the biggest problem with doing too much—the risk of harm."
F) In some cases, the roots of the excess care are noble: Doctors just want to provide the best possible care for their patients. The operating assumption for many both inside and outside the medical field tends to be that if a little care does a little good, a lot of care will do a lot of good. Given the time constraints that many physicians are under, it can seem safest to default to over-ordering.
G) But there are several other major drivers of overutilization (过度医疗) , as well. Experts debate exactly how much the threat of lawsuits influences physicians in their practice of medicine, but physicians themselves say that fear of legal challenges is a substantial factor in motivating them to provide too much care.
H) Skeptics challenge that physicians might not be in the best position to know exactly what motivates their own behavior. But a study published in Health Affairs this summer suggests that the malpractice effect is real. According to the report, doctors who acknowledge having a strong fear of malpractice are more likely to show a pattern of ordering aggressive diagnostic tests, and they’re also more likely to refer patients to the ER (急诊室) for treatment. This makes intuitive sense: Doctors are rarely asked if they did too much, but they are constantly questioned as to whether or not they did enough—and they know they can wind up in legal trouble if patients don’t think their care was sufficient.
I) Perhaps more troubling than medical liability issues are the financial incentives inherent in the American healthcare system. Most American healthcare currently operates on a fee-for-service model, where physicians receive payment for every service performed, regardless of whether that service actually benefits the patient or not. In some cases, especially where physicians self-refer their patients for expensive diagnostic tests and treatments, there can be substantial financial incentives for ordering interventions that might not be medically necessary.
J) Several recent studies have explored whether financial incentives influence how physicians practice, and the answer, unsurprisingly, is that they do. In October, for example, a report in the New England Journal of Medicine examined the "self-referral effect" among urologists (泌尿科医生) treating patients fox prostate cancer (前列腺癌). The study found that doctors are substantially more likely to order radiation therapy for their prostate cancer patients if those doctors have ownership interests in the radiation services they are offering. Over the five-year period from 2005 to 2010, the use of radiation therapy by self-referring urologists in private practice jumped 19.2 percentage points, whereas the rate among their non self-referring peers barely budged, going up just 1.3 percentage points.
K) Jean Mitchell, a professor of public policy at Georgetown University and the author of the report, acknowledges that her study can’t ultimately speak to the motivations of the physicians involved. But she sees reason to be concerned. "There’s been this dramatic trend toward aggressive treatment of prostate cancer, even though basically the clinical data suggest that we should move away from that," she says. "The issue is that it seems like being steered toward the treatment that is going to have the most financial benefit for the urologist."
L) The self-referral effect isn’t unique to radiology. Earlier this summer, a report of the United States Government Accountability Office examined rates of referrals for biopsies (活组织检查) and found that between 2004 and 2010, referrals for biopsies more than doubled among self-referring physicians, even while they increased only 38 percent among those who referred outside their own practices.
M) As physicians, researchers, and policy experts have grown to recognize the problem of excessive care, there have been a number of attempts to combat the problem. One of the most talked-about provisions of Obama’s Affordable Care Act, for example, is the provision for Accountable Care Organizations (ACOs). Under this provision, a network of doctors and hospitals that agrees to act as an ACO receives financial incentives to figure out how to maximize quality while simultaneously reducing costs and eliminating waste in the system. The idea is to encourage healthcare networks to take more collective responsibility for population health and reward better care, rather than simply more care.
N) Physician groups are also stepping up to solve the problem. One widely publicized effort is the Choosing Wisely campaign which is set out to promote conversations between doctors and patients about utilizing the most effective tests and treatments while avoiding unnecessary care. To this end, organizers began calling on physician societies to compile lists of the top five tests and procedures in their respective specialties that were most susceptible to overuse. To date, more than 50 physician societies have joined the campaign, each contributing their own "top 5" list.
O) For Sirovich, these initiatives offer signs of hope. Fifteen years ago, she says, conversations about the harms of medical care or excessive spending weren’t likely to come up, but today, she hears more patients—and fellow physicians—talking about the harms of overuse.
P) But despite hints of change, the problem of overutilization is likely to persist for some time. After all, it took more than a century to construct the current healthcare system, and change does not come easily.
People seldom talked about the harms of medical care or excessive spending fifteen years ago.
选项
答案
O
解析
题干意为,在十五年前,人们很少讨论医疗护理和过度花费的危害。根据题干中的关键词fifteen years ago可定位到O段。该段第二句提到,斯洛维奇说,在十五年前,有关医疗护理和过度开销危害的对话是很难开展的。然而在今天,她听到了更多的病人和医生讨论起了滥用医疗护理的危害。由此可知,题干是对原文的同义转述,故选O。
转载请注明原文地址:https://kaotiyun.com/show/ZMx7777K
0
大学英语六级
相关试题推荐
川剧(SichuanOpera)就像四川火锅以及其他的名菜一样动人、丰富。变脸(FaceChanging)是川剧中的一大亮点。据说古人在他们的脸上作画,以便赶走野生动物。川剧吸收了这一古老的技艺并将其升华为一门艺术。变脸是一门神奇的艺术。演员在不到
新出台的《旅游法》(TourismLaw)的立法主旨之一是为了保护游客的合法权益。据了解,近年来自由行的游客(freewalker)比例一直在不断增加。业内人士表示,之前自由行(DIYtravel)存在不少问题,而在新法中多个条款都规定了旅行社之外的
A、Confident.B、Shocked.C、Nervous.D、Reluctant.A由最后一句话可知女士有信心完成任务。虽然她一开始对于男士找自己帮忙有点意外,但不至于达到B(震惊)的程度。C(紧张)和D(不情愿)就更加不对了。givest
A、Mostpeopleconsumeasimilaramountofsalt.B、Americanseatlesssaltthantheothers.C、Differentpeopleeatdifferentamou
A、Dreamswerealwaysmisleading.B、Dreamshadtheirownspecificmeanings.C、Dreamscouldhelpexplainourbrainactivities.D、T
A、Tuesdaymorning.B、Tuesdayafternoon.C、Thursdaymorning.D、Thursdayafternoon.B男士说,葬礼在星期二举行,遗体吊唁仪式安排在下午。所以答案是B。对话提到两个时间点,星期二
A、WhentheEngland’sKingplannedtosendtroopstocontroltherebellion.B、WhenthedelegatesattendedtheFirstContinentalC
A、HelearnedalotfromhisstudyinEngland.B、Helearnedmanyforeignlanguagesinhiscollege.C、Hewassatisfiedwithhised
A、Theyarethesmallestsatellites.B、Theyaremadebycollegestudents.C、Theyarepoweredbywater.D、TheyarebackedbyNASA.
A、TotheRoyalIslandPark.B、TothenorthofSydney.C、TotheRoyalNationalPark.D、TotheGariebeach.C对话中男士说,他们打算南下去RoyalN
随机试题
联系实际论述迈克尔.波特关于决定行业内部竞争状态的五种基本竞争作用力。
脊髓灰质炎患者发生肢体肌肉萎缩的主要原因是
急性细菌性前列腺炎是主要致病菌
A.引起嗜睡B.致使视物模糊C.致使定向力障碍D.引起多尿或多汗E.致使眩晕或腹痛驾驶员慎用双氯芬酸的原因是()。
下列各项中,属于注册会计师及其所在的会计师事务所可依法承办的审计业务的是()。
对仲裁司法监督的实现方式主要是()。
一条河的水流速度为每小时4千米。一条船以恒定的速度逆流航行6千米后,再返回原地,共耗时2小时(不计船掉头的时间)。请问:船逆流航行与顺流航行的速度之比是多少?
老年人的味觉功能有所减退,常常是食而无味,总喜欢吃口味重的食物来增强食欲,这样无意中就增加了盐的摄入量。盐吃多了会加重肾的负担,可能降低口腔黏膜的屏障作用,增加感冒病毒在上呼吸道生存和扩散的几率。因此,老年人每天的食盐摄入量应控制在5克左右,同时要少吃酱肉
ThenewprestigeoftheBritishgraduatesisthemostspectacularbecauseinthepastBritainhasbeenmuch【1】interestedinuniv
以下程序运行后的输出结果是______。main(){charc1,c2;for(c1=’0’,c2=’9’;c1<c2;c1++,c2--)printf("%c%c",c1,c2);printf("\n");}
最新回复
(
0
)