六级阅读第十四天 完整版.pdfVIP

PassageTwo Questions 57to 61are basedonthe following passage. Crippling healthcare bills, longemergency-roomwaits andthe inability tofind a primarycare physicianjust scratchthe surfaceofthe problemsthat patientsface daily. Primary care should be the backbone of any health care system. Countries with appropriate primary care resources score highly when it comesto healthoutcomesandcost.The U.S.takestheoppositeapproach by emphasizingthe specialist ratherthan the primarycare physician. recent study analyzed the providerswho 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. Howdidwe letprimarycareslipsofar?The keyishowdoctorsare paid. Mostphysiciansarepaidwheneverthey performamedicalservice.The more aphysiciandoes,regardlessofqualityoroutcome,thebetterhe’sreimbursed (返还费用). Moreover,the amount a physician receives leans heavilytoward medical or surgical procedures. specialist who performs a procedure in a 30-minutevisit can be paidthree times morethan a primary care physician usingthat same 30 minutesto discuss a patient’s disease. Combinethis fact with annual government threats to indiscriminately cut reimbursements, physiciansarefacedwith nochoicebutto increasequantityto boostincome. 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 primarycare. Medicalstudentsarenotblindtothisscenario.Theyseehowheavilythe reimbursement deck is stacked against primary care. The recent numbers show that since 1997, newly graduated U.S. medical students who choose primary