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The Impendent Crisis of Health Care System
即将来临的医保危机
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.
日益上涨的医保费用，急诊室内长时间的等待，初级保健医生的短缺，这些都只是患者日常面临的一小部分问题。
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.
初级保健应该是整个医保制度的支柱。在谈到健康状况和医疗费用时，初级保健资源完善的国家情况令人满意。美国却反其道而行，重视专门医生而非初级保健医生。
A recent study analyzed the providers who treat Medicare beneficiaries（老年医保受惠人）. 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，一项研究对负责老年医保受惠人的医生进行了调查分析。令人惊讶的发现是，每个受惠人每年平均看的医生多达七位——两个初级保健医生和五个专科医生。
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.
与人们普遍的想法相反，照顾你的医生越多并不能证明医疗保健的效果越好。事实上，医保越分散，医疗费用会越高，医疗错误也越多。
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（返还费用）. Moreover, the amount a physician receives leans heavily toward medical or surgical procedures.
为什么我们如此不重视初级保健呢？问题的关键在于医生的收费制度。大多数医生，无论何时，只要他们给人看病就可以收取费用。医生出诊的次数越多，无论医疗效果如何，他们获得的费用也会越多。另外，医生在收费时，在很大程度上是按看诊过程或手术内容进行的。
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.
一个专业医生看诊30分钟收取的费用是一个初级保健医生同样时间问诊费用的3倍。考虑到以上原因，再加之政府每年随意削减医生诊费，医生们别无他法，只能靠增加问诊次数来提高收入。
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.
不愿只求数量而忽视医疗效果的初级保健医生或者关门歇业，或者弃医从商，使初级保健的状况进一步恶化。
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.
医科专业的学生并非没有意识到这一情况，他们认识到费用返还制度对初级医保极其不利。最近的数据显示，自1997年以来，美国医科毕业生选择初级保健作为职业的人数已下降50%。这一趋势导致急诊室内人满为患，医生短缺。
