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  • 试题题型【阅读理解 Section B】

A. For people who had been awaiting the rollout of the Affordable Care Act in order toobtain health insurance for the first time, the major problem associated with Americanhealthcare 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 muchhealthcare. 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 oftotal healthcare expenditures in America go toward unneeded care. Doctors, too, haveacknowledged the problem: In a 2011 survey published in the Archives of InternalMedicine,42 percent of American primary care physicians said that patients in theirown practice were getting more care than necessary.
C.Excessive care typically takes the form of overabundant referrals ( 转诊病人 ) tospecialists, more diagnostic tests than would be medically necessary, or too manyprescriptions--but in some cases, it can extend to actual treatments or surgeriesthat are not clinically indicated. Richard Baron, president of the American Board ofInternal Medicine, is candid ( 直言不讳的) about the problem. "There were and arelots 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 carecould be a problem. But unneeded healthcare can be physically damaging. "Anythingwe do in medicine and healthcare has expected benefits and harms," says BrendaSirovich, 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 thereis also the chance that it's going to do some harm."
Even for initial screening tests that pose no risk in themselves, there's the problemof the "downstream effect"; if the first test produces an ambiguous result or a falsepositive, it can lead to more invasive testing that does carry substantial risk. "As youintervene on patients who have less and less reason to intervene and less and lesschance 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."
In some cases, the roots of the excess care are noble: Doctors just want to provide thebest possible care for their patients. The operating assumption for many both insideand outside the medical field tends to be that if a little care does a little good, a lot ofcare 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 ( 过渡医疗 ) , as well.
Experts debate exactly how much the threat of lawsuits influences physicians in theirpractice of medicine, but physicians themselves say that fear of legal challenges is asubstantial factor in motivating them to provide too much care.
H.Skeptics challenge that physicians might not be in the best position to know exactlywhat motivates their own behavior. But a study published in Health Affairs thissummer suggests that the malpractice effect is real. According to the report, doctorswho acknowledge having a strong fear of malpractice are more likely to show apattern of ordering aggressive diagnostic tests, and they're also more likely to referpatients to the ER ( 急诊室 ) for treatment. This makes intuitive sense: Doctors arerarely asked if they did too much, but they are constantly questioned as to whetheror not they did enough--and they know they can wind up in legal trouble if patientsdon't think their care was sufficient.
I.Perhaps more troubling than medical liability issues are the financial incentivesinherent in the American healthcare system. Most American healthcare currentlyoperates on a fee-for-service model, where physicians receive payment for everyservice performed, regardless of whether that service actually benefits the patient ornot. In some eases, especially where physicians self-refer their patients for expensivediagnostic tests and treatments, there can be substantial financial incentives forordering interventions that might not be medically necessary.
J.Several recent studies have explored whether financial incentives influence howphysicians practice, and the answer, unsurprisingly, is that they do. In October, forexample, a report in the New England Journal of Medicine examined the "self-referraleffect" among urologists ( 泌尿科医师 ) treating patients for prostate cancer ( 前列腺癌) . The study found that doctors are substantially more likely to order radiationtherapy for their prostate cancer patients if those doctors have ownership interests inthe 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 jumped19.2 percentage points, whereas the rate among their non self-referring peers barelybudged, going up just 1.3 percentage points.
K. Jean Mitchell, a professor of public policy at Georgetown University and the authorof the report, acknowledges that her study can't ultimately speak to the motivationsof the physicians involved. But she sees reason to be concerned. "There's been thisdramatic trend toward aggressive treatment of prostate cancer, even though basicallythe clinical data suggest that we should move away from that," she says. "The issueis that it seems like being steered toward the treatment that is going to have the mostfinancial benefit for the urologist."
L. The self-referral effect isn't unique to radiology. Earlier this summer, a report ofthe United States Government Accountability Office examined rates of referrals forbiopsies (活组织检查 ) and found that between 2004 and 2010, referrals for biopsiesmore than doubled among self-referring physicians, even while they increased only38 percent among those who referred outside their own practices.
M. As physicians, researchers, and policy experts have grown to recognize the problemof excessive care, there have been a number of attempts to combat the problem. Oneof 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 financialincentives to figure out how to maximize quality while simultaneously reducing costsand eliminating waste in the system. The idea is to encourage healthcare networks totake more collective responsibility for population health and reward better care, ratherthan simply more care.
N. Physician groups are also stepping up to solve the problem. One widely publicizedeffort is the Choosing Wisely campaign which is set out to promote conversationsbetween doctors and patients about utilizing the most effective tests and treatmentswhile avoiding unnecessary care. To this end, organizers began calling on physiciansocieties to compile lists of the top five tests and procedures in their respectivespecialties that were most susceptible to overuse. To date, more than 50 physiciansocieties 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 tocome up, but today, she hears more patients--and fellow physicians--talking aboutthe harms of overuse.
P. But despite hints of change, the problem of overutilization is likely to persist for sometime. After all, it took more than a century to construct the current healthcare system,and change does not come easily.

1.[选词填空]Physicians say that fear of legal challenges is one of the factors that motivate them toprovide too much care.
    • 解题思路:题干意为,医师们说对医疗纠纷的恐惧是驱使他们提供过度医疗的因素之一。根据题干中的关键词too much care和fear of legal challenges可定位到G段。该段第二句提到,医师们表示,对医疗纠纷的恐惧正是他们提供过度医疗护理的一个重要推动力。由此可知,题干是对原文的同义转述,故选G。
    2.[选词填空]Some Americans are expecting their first health insurance via the Affordable CareAct, while there are a surprising number of Americans receiving too much healthcare.
      • 解题思路:题于意为,一些美国人正期待通过《平价医疗法案》获得自己的第一份医疗保险,而有数量惊人的美国人正在接受过度的医疗护理。根据题干中的关键词theAffordable Care Act和receiving too much healthcare可定位到A段。该段第一句和第二句提到,对于那些正在期待《平价医疗法案》的首次登场以便获得自己的第一份医疗保险的人们来讲,美国医疗所面临的主要问题便是缺乏获得医保的途径。然而有数量惊人的美国人,他们所面临的最大问题则恰恰相反:他们正在接受过度的医疗护理。由此可知,题干是对原文的同义转述,故选A。
      3.[选词填空]One noble reason for excess care is that sometimes doctors just want to provide thebest possible care for the patients.
        • 解题思路:题干意为,过度医疗的一个高尚的原因是:医生们希望给病人提供尽可能好的医疗。根据题干中的关键词noble reason和best possible care可定位到F段。该段首句提到,在某些情况下,过度医疗的根源却是非常高尚的:医生们仅仅是想为病人们提供尽可能好的治疗而已。由此可知,题于是对原文的同义转述,故选F。
        4.[选词填空]People seldom talked about the harms of medical care or excessive spending fifteenyears ago.
          • 解题思路: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fiReen years ago可定位到0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。
          5.[选词填空]Doctors may be involved in legal trouble if their patients think they did not provideenough care.
            • 解题思路:题干意为,如果病人认为医生没有提供足够的治疗,医生们可能会被卷入法律纠纷。根据题干中的关键词doctors和legal trouble可定位到H段。该段末句提到,医生们很清楚,如果病人认为自己接受的治疗不够充分的话,他们就会卷入法律纠纷。由此可知,题干是对原文的同义转述,故选H。
            6.[选词填空]According to a 2011 study, nearly half of American primary care physicians agreedthat patients may get more care than necessary.
              • 解题思路:题干意为,根据一项2011年的调查研究,将近一半的美国初级护理医师承认病人们可能接受了不必要的医疗护理。根据题干中的关键词a 2011 study可定位到8段。该段第二句提到,一项2011年刊登在《内科学文献》杂志上的调查研究显示,有42%的初级护理医师表示,在他们的实际工作中,有许多患者都在接受不必要的医疗护理。由此可知,题干是对原文的同义转述,故选B。
              7.[选词填空]Stimulated by the financial incentives, some physicians will advise patients to takeexpensive examinations in order to get higher income.
                • 解题思路:题干意为,在财政激励政策的刺激下,一些医生为了获得更高的收入,通常会建议病人去接受昂贵的检查。根据题干中的关键词financial incentives,physicians和patients可定位到I段。该段末句提到,在某些情况下,特别是当医生们主动要求病人去接受昂贵的诊断测试或治疗时,他们很大程度上是在财政激励政策的影响下要求病人接受那些或许根本没有医学必要的医疗干预。由此可知,题干是对原文的同义转述,故选I。
                8.[选词填空]All the things doctors do in medicine and healthcare may bring both benefits andharms.
                  • 解题思路:题干意为,医生在用药和医疗护理上所做的所有事情都有可能同时带来益处和损害。根据题干中的关键词benefits and harms可定位到D段。该段第三句引用退伍军人医疗中心的研究助理布兰达·斯洛维奇的话说到,我们在用药和医疗护理上所做的任何事情都会为患者带来益处和损害。由此可知,题干是对原文的同义转述,故选D。
                  9.[选词填空]Though there are hints of change, the problem of overutilization is still not going tobe solved in a short time.
                    • 解题思路:题干意为,尽管改变的迹象已然出现,但是过度医疗问题在短时间内仍然得不到解决。根据题干中的关键词hints ofchange可定位到P段。该段首句提到,尽管改变的迹象已然出现,但是过度医疗的问题仍旧会持续一段时间,要想改变它并非易事。由此可知,题干是对原文的同义转述,故选P。
                    10.[选词填空]The provision for Accountable Care Organizations has the thought of encouraginghealthcare networks to be collectively more responsible for Americans' health andreward better care.
                      • 解题思路:题干意为,对可信赖医疗组织的规定其想法是鼓励医疗保健网络更多地承担美国人健康的集体责任,并回报以更高质量的医疗服务。根据题干中的关键词AccountableCare Organizations.encouraging healthcare networks和reward better care可定位到M段。该段末句提到,此规定的想法是鼓励医疗保健网络更多地承担人口健康的集体责任,并为人们提供质量更高的医疗服务,而非更多的服务。由此可知,题干是对原文的同义转述,故选M。
                      • 参考答案:G,A,F,O,H,B,I,D,P,M