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The Impendent Crisis of Health Care System
即將來臨的醫保危機
Cripping health care bills, long emergency-room waits and the inability to find a primary care physician just scratch the surface of the problems that patients face daily.
日益上漲的醫保費用，急診室內長時間的等待，初級保健醫生的短缺，這些都只是患者日常面臨的一小部分問題。
Primary care should be the backbone of any health care system. Countries with appropriate primary care resources score highly when it comes to health outcomes and cost. The U.S. takes the opposite approach by emphasizing the specialist rather than the primary care physician.
初級保健應該是整個醫保制度的支柱。在談到健康狀況和醫療費用時，初級保健資源完善的國家情況令人滿意。美國卻反其道而行，重視專門醫生而非初級保健醫生。
A recent study analyzed the providers who treat Medicare beneficiaries（老年醫保受惠人）. The startling finding was that the average Medicate patient saw a total of seven doctors - two primary care physicians and five specialists - in a given year.
最近，一項研究對負責老年醫保受惠人的醫生進行了調查分析。令人驚訝的發現是，每個受惠人每年平均看的醫生多達七位——兩個初級保健醫生和五個專科醫生。
Contrary to popular belief, the more physicians taking care of you doesn't guarantee better care. Actually, increasing fragmentation of care results in a corresponding rise in cost and medical errors.
與人們普遍的想法相反，照顧你的醫生越多并不能證明醫療保健的效果越好。事實上，醫保越分散，醫療費用會越高，醫療錯誤也越多。
How did we let primary care slip so far? The key is how doctors are paid. Most physicians are paid whenever they perform a medical service. The more a physician does, regardless of quality or outcome, the better he's reimbursed（返還費用）. Moreover, the amount a physician receives leans heavily toward medical or surgical procedures.
為什么我們如此不重視初級保健呢？問題的關鍵在于醫生的收費制度。大多數醫生，無論何時，只要他們給人看病就可以收取費用。醫生出診的次數越多，無論醫療效果如何，他們獲得的費用也會越多。另外，醫生在收費時，在很大程度上是按看診過程或手術內容進行的。
A specialist who performs a procedure in a 30-minute visit can be paid three times more than a primary care physician using that same 30 minutes to discuss a patient's disease. Combine this fact with annual government threats to indiscriminately cut reimbursements, physicians are faced with no choice but to increase quantity to boost income.
一個專業醫生看診30分鐘收取的費用是一個初級保健醫生同樣時間問診費用的3倍。考慮到以上原因，再加之政府每年隨意削減醫生診費，醫生們別無他法，只能靠增加問診次數來提高收入。
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 primary care.
不愿只求數量而忽視醫療效果的初級保健醫生或者關門歇業，或者棄醫從商，使初級保健的狀況進一步惡化。
Medical students aren't blind to this scenario. They see how heavily the reimbursement deck is stacked against primary care. The recent numbers show that since 1997, newly graduated U.S. medical students who choose primary care as a career have declined by 50%. This trend results in emergency rooms being overwhelmed with patients without regular doctors.
醫科專業的學生并非沒有意識到這一情況，他們認識到費用返還制度對初級醫保極其不利。最近的數據顯示，自1997年以來，美國醫科畢業生選擇初級保健作為職業的人數已下降50%。這一趨勢導致急診室內人滿為患，醫生短缺。
