考试时间 2014年3月22日星期六 下午2:00-5:00 原创作者qq 347952582 \2>?6zs
Passage 72(9/22) Xm|ib%no
SinceWould War II considerable advances have been made in the area of health-careservices. These include better access to health care (particularly for the poorand minorities), improvements in physical plants, and increased numbers ofphysicians and other health personnel. All have played a part in the recentimprovement in life expectancy. But there is mounting criticism of the largeremaining gaps in access, unbridled cost inflation, the further fragmentationof service, excessive indulgence in wasteful high-technology “gadgeteering,”and a breakdown in doctor-patient relationships. In recent years, proposed panaceas and new programs,small and large, have proliferated at a feverish pace and disappointmentsmultiply at almost the same rate. This has led to an increasedpessimism—“everything has been tried and nothing works”—which sometimes borderson cynicism or even nihilism. _*E!gPO
Itis true that the automatic “pass through” of rapidly spiraling costs togovernment and insurance carriers, which was set in a publicized environment of“the richest nation in the world,” produced for a time a sense of unlimitedresources and allowed to develop a mood whereby every practitioner andinstitution could “do his own thing” without undue concern for the “MedicalCommons.” The practice of full-cost reimbursement encouraged capital investmentand now the industry is overcapitalized. Many cities have hundreds of excesshospital beds; hospitals have proliferated a superabundance of high-technologyequipment; and structural ostentation and luxury were the order of the day. Inany given day, one-fourth of all community beds are vacant; expensive equipmentis underused or, worse, used unnecessarily. Capital investment brings rapidlyrising operating costs. [PWL<t::c
Yet,in part, this pessimism derives from expecting too much of health care. It mustbe realized that care is, for most people, a painful experience, oftenaccompanied by fear and unwelcome results. Although there is vast room forimprovement, health care will always retain some unpleasantness andfrustration. Moreover, the capacities of medical science are limited. HumptyDumpty cannot always be put back together again. Too many physicians arereluctant to admit their limitations to patients; too many patients andfamilies are unwilling to accept such realities. Nor is it true that everythinghas been tried and nothing works, as shown by the prepaid group practice plansof the Kaiser Foundation and at Puget Sound. In the main, however, suchundertakings have been drowned by a veritable flood of public and privatemoneys which have supported and encouraged the continuation of conventionalpractices and subsidized their shortcomings on a massive, almost unrestricted scale.Except for the most idealistic and dedicated, there were no incentives to seekchange or to practice self-restraint or frugality. In this atmosphere, it isnot fair to condemn as failures all attempted experiments; it may be moreaccurate to say many never had a fair trial. >1ZJ{se
1. The author implies that the KaiserFoundation and Puget Sound plans (lines 47-48) differed from other plans by vv+J0f^
(A)encouraging capital investment !ni>\lZ
(B)requiring physicians to treat the poor _a5(s2wq+
(C)providing incentives for cost control 9/kXc4
(D)employing only dedicated and idealistic doctors IzUo0D*@
(E)relying primarily on public funding Uc&iZFid2K
2. The author mentions all of the following asconsequences of full-cost reimbursement EXCEPT Gx'TkU=
(A)rising operating costs N wtg%;
(B)underused hospital facilities /S~m)$vu
(C)overcapitalization tsv$ r$Se
(D)overreliance on expensive equipment
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(E)lack of services for minorities JE;+T[I
3. The tone of the passage can best bedescribed as 1*UNsEr
(A)light-hearted and amused B42sb_
(B)objective but concerned ,}J_:\j
(C)detached and unconcerned >]?H`>4(
(D)cautious but sincere cdTsRS;E
(E)enthusiastic and enlightened =SBBvnPLI
4. According to the author, the “pessimism”mentioned at line 35 is partly attributable to the fact that X
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(A)there has been little real improvement in health-care services Jpj!rXTX*
(B)expectations about health-care services are sometimes unrealistic >/^#Drwb!i
(C)large segments of the population find it impossible to get access tohealth-care services /:[2'_Xl
(D)advances in technology have made health care service unaffordable O#_b7i
(E)doctors are now less concerned with patient care !;3PG9n3|h
5. The author cites the prepaid plans in lines46-48 as _[K#O,D,
(A)counterexamples to the claim that nothing has worked z"
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(B)examples of health-care plans that were over-funded :&w{\-0{
(C)evidence that health-care services are fragmented jbmTmh1q
(D)proof of the theory that no plan has been successful }Je>
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(E)experiments that yielded disappointing results f3tv3>p
6. It can be inferred that the sentence“Humpty Dumpty cannot always be put back together again” means that
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(A)the cost of health-care services will not decline r\M9_s8
(B)some people should not become doctors uTvv(f
(C)medical care is not really essential to good health 6}dR$*=
(D)illness is often unpleasant and even painful yR71%]*.
(E)medical science cannot cure every ill 0ejdKdYN
7. With which of the following descriptions ofthe system for the delivery of health-care services would the author mostlikely agree? Q^_/By@
(A)It is biased in favor of doctors and against patients. Mz=!w]qDH
(B)It is highly fragmented and completely ineffective [=%YV# O
(C)It has not embraced new technology rapidly enough &KC!*}<tx
(D)It is generally effective but can be improved SUtf[6
(E)It discourages people from seeking medical care adO&