UNIT 3 HEALTHCARE
Vocabulary 1 (Healthcare)
Health service; National Health Service (NHS)
Public health care; private health care
Health-authority control
Sickness/maternity/disability benefits
Local family doctor; general practitioner (GP); house calls
To cut the number of hospital beds
Waiting lists for operations, treatment
Preventive care services; inpatient hospital and post-acute care
Community care (caring in the community); community-based services
To offer tax concessions to donors
Charity campaigns; to raise money; donations
Medical insurance; health insurers
To pay a contribution to the national insurance and health schemes
Compulsory insured weekly wage earners
To be on a doctors “panel”; to consult a doctor
Independent contractor
Capitation fee
Ancillary staff
X-ray department, emergency room (casualty department); surgery
Medical appliances; dentures
Outpatient prescription drugs; outpatient costs; out-of-pocket drug costs
Adverse effects
Cardiovascular diseases
USA: Medicaid (free medical and hospital care); Medicare (medical and hospital care for older Americans(over age 65))
Vocabulary 2 (Hospitals)
not-for-profit hospitals; proprietary (for-profit) hospitals
nursing care
acquired immune deficiency syndrome (AIDS)-related cancers
brain tumors
ovarian cancer
state-of-the-art treatments
photodynamic therapy
to activate cancer-killing chemicals
tertiary care centers
heart/lung/liver transplants
to train residents (medical school graduates who are doing postgraduate training)
laboratory specialists
university-based academic medical centers
referral centers
trauma center
American Hospital Association (AHA)
nursing homes.
life-threatening illnesses
debilitating diseases
to be spearheaded by individuals
investor-owned hospital chains
Hospital Corporation of America (HCA)
to yield corporate profits
health maintenance organization (HMO)
gravely ill patients (trauma and burn victims)
premature newborns
psychiatric or chronic care institutions.
dependents
hospitalized patient
to reduce the skyrocketing costs of hospital care
managed care
financial constraints
to lay off employees
knee replacement
Note:
Roswell Park Cancer Institute in Buffalo
Kaiser Permanente of Oakland, California
Cook County Hospital in Chicago, Illinois
Walter Reed Army Medical Center, in Washington, D.C.
the 112-bed Polk County Florida Hospital
the District of Columbia General Hospital
Study the texts, translate the italicized words and expressions.
Using the underlined words and expressions, make up your own sentences and translate them.
TEXT 1
NATIONAL HEALTH SERVICE
The National Health Service (NHS) was set up in the UK in 1948 to provide healthcare for all citizens, based on need, not the ability to pay. It is made up of a wide range of health professionals, support workers and organisations. Around one million people work for the NHS in England and it costs more than Ј50 billion a year to run. This will rise to Ј69 billion by 2005.
The NHS aims to bring about the highest level of physical and mental health for all citizens, within the resources available, by: a) promoting health and preventing ill-health; b) diagnosing and treating injury and disease; c) caring for those with a long-term illness and disability, who require the services of the NHS.
The NHS is funded by the taxpayer. This means it is accountable to Parliament. It is managed by Department of Health. The department sets overall health policy in England and is responsible for enforcing it. It also sets targets for the NHS and monitors performance through its eight regional offices.
Painful past of public health care
The NHS formed on July 5, 1948 was the end-product of a public-health system which had gradually emerged during more than 100 years.
Before the early 19th century, thousands of children and older people, unable to obtain medical help, died each year from tuberculosis, cholera and other diseases. In 1834, the Poor Law Amendment Act ordered local workhouses, where unemployed people were put to work in exchange for their board and lodging, to set up sick wards. In 1848, the government brought these wards under a central body - the General Board of Health.
As the workhouse wards grew in size and number they became known as "poor-law hospitals", which offered free treatment to patients but were unpopular. More popular were the "voluntary" hospitals run by religious or charitable bodies. They offered some care free of charge, but they also expected wage-earners and employers to pay through insurance schemes.
Wage-earners generally paid a regular contribution to a trade union or similar association. The contributions covered care in voluntary hospitals as well as the services of local family doctors, called general practitioners or GPs. But many people could still not afford to see a GP.
When the second Boer War (1899 to 1902) broke out in South Africa between the British and Dutch settlers, nearly half of all British recruits had to be rejected from the army because of poor health. Four times as many soldiers died during the war from disease as from fighting.
Fears that ill health would weaken the British army and threaten the nation's security abroad added to a general concern that the nation's health should be improved for its own sake. This prompted a series of health reforms. In 1911, David Lloyd George, a member of the Liberal government, introduced a bill that became the National Health Insurance Act. This extended health insurance to lower-paid workers so that they could obtain the services of GPs. A Ministry of Health was set up in 1919. This brought poor-law hospitals under the control of local authorities in 1929.
Once war broke out in 1939, the government set up an Emergency Medical Service to treat both military and civilian casualties. For the first time the government took direct day-to-day control of both voluntary and local-authority hospitals. It also agreed to pay for casualty (emergency) services, which until then had been paid for by patients' contributions, local-authority rates and charity.
In 1942, an influential report on social welfare services stated that the only way to improve living standards was to provide a complete range of health services to all citizens. In 1946, the Labour government passed legislation which created the National Health Service. From 1948, all citizens, rich or poor would be entitled to equal access to health care.
But the problem that has confronted successive British governments has been how to control the cost of the NHS while meeting the nation's health-care needs. Over the past years, health spending has risen steadily. New methods of treating illnesses, especially new techniques in surgery, have forced hospitals to buy expensive equipment. The cost of drugs has also grown at a rate well above inflation. There are also more pensioners in the UK than ever before - the main group using the NHS. Many NHS hospitals have been forced to close wards and cut the number of their beds in order to save money. For example, English hospitals lost about 75,000 out ' of about 350,000 beds between 1979 and 1989, according to the Department of Health.
In December 1987, a number of bodies representing doctors warned that the NHS had reached financial breaking-point. The next month, Margaret Thatcher, then prime minister, announced a fundamental review of the NHS.
The NHS experienced the most significant cultural shift since its inception with the introduction of the so-called internal market. The internal market was the Conservative Government's attempt to address problems, such as growing waiting lists, which had arisen in the 1980s as a result of NHS resources being constrained while demand rose inexorably.
Before the 1990 Act a monolithic bureaucracy ran all aspects of the NHS. After the establishment of the internal market, 'purchasers' (health authorities and some family doctors) were given budgets to buy health care from 'providers' (acute hospitals, organisations providing care for the mentally ill, people with learning disabilities and the elderly, and ambulance services).
To become a 'provider' in the internal market, health organisations became NHS trusts, independent organisations with their own managements, competing with each other. The first wave of 57 NHS Trusts came into being in 1991. By 1995, all health care was provided by NHS trusts. Over the same period, many family doctors were also given their own budgets with which to buy health care from NHS trusts in a scheme called GP fund holding. Not all GPs joined this scheme and their budgets were still controlled by health authorities, which bought health care 'in bulk' from NHS trusts.
Patients of GP fund holders were often able to obtain treatment more quickly than patients of non-fund holders. This led to accusations of the NHS operating a two tier system, contrary to the founding principles of the NHS of fair and equal access for all to health care.
The New NHS: Modern, Dependable
Observers credit the internal market with improving cost consciousness in the NHS, but at a price: that the competition it encouraged between 'providers' saw unnecessary duplication of services.
The election of a new Government in May 1997 brought a new approach to the NHS. Pledging itself to abolition of the internal market, the new Government set out an approach which aimed to build on what had worked previously, but discarding what had failed.
As the NHS entered its 50th year, a new era had begun. The NHS Plan - which was published in July 2000 - is a radical action plan for the next 10 years setting out measures to put patients and people at the heart of the health service. The main theme of the changes is to replace the competition engendered by the internal market with a new ethos of co-operation. The NHS Plan promises more power and information for patients, more hospitals and beds, more doctors and nurses, much shorter waiting times for hospital and doctor appointments, cleaner wards, better food and facilities in hospitals, improved care for older people, tougher standards for NHS organisations and better rewards for the best.
The New NHS: Fit for the future?
The NHS is undergoing a radical restructuring - but critics fear that without new investment the same problems will continue to blight the service.
The government is to replace GP fundholding with a system of primary care groups (PCGs) designed to ensure that all patients are treated the same. GPs - together with other health and social services professionals - will join forces in PCGs covering approximately 100,000 patients to decide together how to purchase hospital services.
PCGs will have to work to a three-year Health Improvement Programme drawn up by the local health authority to ensure a consistent approach across a locality. The government has also stressed that hospitals, which under the Tories were encouraged to compete for business, must now co-operate to ensure that patients get the best care possible.
Many GPs have welcomed the introduction of PCGs as way to reduce inequality in the NHS. But they also fear that the new system could be a way for politicians to shirk their responsibility for underfunding in the NHS. With finite resources available, and demand seemingly infinite, GPs warn that it is inevitable that some treatments will have to be rationed, particularly as the new system will inherit the debts run up in previous years.
They fear that rather than blame the politicians for failing to put sufficient funds into the health service, patients will blame their doctor if they are told that treatment is being denied. A survey by Doctor magazine found that 82% GPs thought they would be held more personally accountable for rationing decisions under the new system. With intense pressures on budgets, GPs are also worried their clinical freedom to prescribe and refer in the best interests of their patients will be curtailed in the quest to save money.
TEXT 2
THE ORIGINS OF COMMUNITY CARE
Care in the community represented the biggest political change in mental healthcare in the history of the NHS. It was the result both of social changes and political expediency and a movement away from the isolation of the mentally ill in old Victorian asylums towards their integration into the community. The aim was to "normalise" the mentally ill and to remove the stigma of a condition that is said to afflict one in four of the British population at some time in their lives.
The main push towards community care came in the 1950s and 1960s, an era which saw a sea of change in attitude towards the treatment of the mentally ill and a rise in the patients' rights movement, tied to civil rights campaigns. The 1959 Mental Health Act abolished the distinction between psychiatric and other hospitals and encouraged the development of community care. Through the 1960s, the tide continued to move against the big hospital institutions. Psychiatrists questioned traditional treatments for mental illness. R.D. Laing, for example, suggested that social rather than medical reasons were responsible for schizophrenia. He also opposed the standard treatments for the illness, including electro-convulsive therapy and hospitalisation.
The introduction of a new wave of psychotropic drugs in the 1960s also meant patients could be more easily treated outside of an institution. Another significant development was the growth of patients' and civil rights movements and the increase in charities which championed them.
Coupled with this were changes in social attitudes. In the first part of the century, for example, asylums were used to house a wide variety of people, including single women who had fallen pregnant. Many remained there throughout their lives. In addition, right-wing civil libertarians argued that mental hospitals were effectively prisons, preventing a return to normal life. There was also a belief that community care would be cheaper than hospital care, although in recent years mental health campaigners have consistently argued that, if properly funded, it is more expensive.
During the 1970s, large-scale psychiatric hospitals were steadily discredited. The new district general hospitals which provided some psychiatric services contributed to the reduction in the number of beds in mental hospitals from 150,000 in the mid-1950s to 80,000 by 1975.
The 1980s saw the introduction of legislation which would give the mentally ill more rights. The Mental Health Act 1983 set out the rights of people admitted to mental hospitals, allowing them to appeal against committal. However, by the 1980s concerns were being expressed about care in the community following a series of killings by people with mental health problems. The 1984 murder of social worker Isabel Schwarz by a former client prompted a government inquiry into community care, led by Sir Roy Griffiths, whose 1988 report was the forerunner to the Community Care Act of 1990.
At present some people argue that care in the community has been discredited in the public mind by a series of crimes committed by the mentally ill who had fallen between the gaps or come off their medication. Many now feel that care in the community was implemented too quickly with inappropriate patient selection and in too many places, there was too little investment in training, finance and related areas. There has been, at times, too little care, scant support, and a form of community which has exposed the vulnerable - both patients and the public - to danger.
TEXT 3
HEALTH INSURANCE
In the United States private organizations have traditionally provided the vast majority of health insurance coverage. The U.S. government operates some publicly funded health insurance programs but access is limited to specific groups, such as the poor and the elderly. Most Americans obtain private health insurance through their places of employment.
Americans pay the cost of health insurance in a variety of ways. Workers may pay for private health insurance by authorizing their employers to deduct a specified amount from their paychecks. Alternatively, individuals may work for employers who pay the direct costs of health insurance. People who do not receive health insurance through their jobs or through government programs can purchase private health insurance policies by paying premiums directly to an insurance company.
According to the U.S. Census Bureau, about 43.4 million people in the United States (about 16.1 percent of the population) lack health insurance coverage. Those without insurance are usually self-employed, work part-time, or work in low-wage jobs, so they lack access to low-cost, employer-sponsored group plans. Many of these workers cannot afford to purchase individual health care insurance, but they do not qualify for coverage under government programs for low-income Americans. Nevertheless, even without insurance, these individuals may be able to receive care without charge or at reduced rates in government-run hospitals.
Although millions of Americans lack health insurance because they cannot afford it, many others cannot buy health insurance because insurers consider them at especially high risk of needing expensive health care. Insurers assess the risks posed by applicants for insurance and then group applicants into similar classes of risk. Americans who are considered average or better-than-average risks can usually purchase insurance policies at a relatively affordable price. When an applicant presents too much risk, however, private companies consider it difficult or even impossible to offer insurance coverage to that person.
For example, some private companies will not offer coverage to an individual with a known predisposition to develop cancer. Also, the few companies willing to insure such high-risk individuals will charge higher premiums to assume the risks. Increased premiums often make the insurance policy unaffordable to high-risk individuals. Even worse, occasionally no insurance company will offer a policy to a person who presents an exceptionally high risk of needing expensive medical care, such as a person infected with the virus that causes acquired immunodeficiency syndrome (AIDS).
Some insurance companies have introduced clauses to their policies that are designed to keep costs down by denying access to private insurance for anyone who already suffers from significant medical conditions. Introduction of preexisting condition clauses in insurance policies became especially widespread in the 1980s and early 1990s. Many workers found it virtually impossible to change jobs if any member of their families had a serious health problem because preexisting condition clauses in their new employer-sponsored plan would deny them access to insurance coverage. The Congress of the United States addressed this problem by introducing the Health Insurance Portability Act of 1996, which requires most employer-sponsored plans to accept transfers from other plans without imposing a preexisting condition clause.
The costs of health care have increased dramatically for consumers and insurers, particularly during the 1980s and early 1990s. For example, in 1980 Americans spent $247.2 billion on health care. By 1995 that figure had more than quadrupled to $1.04 trillion.
One reason costs have risen is that Americans are living longer than ever before, and older people generally require more health care. In 1900 the average American had a life expectancy of 49.2 years. Today the average American is expected to live more than 75 years. When older Americans join an insured group, the whole group's health care risks—and costs—rise accordingly.
Advances in medical technology have also driven up the costs of health care and insurance. Medical procedures such as computerized tomography (CT) scans, magnetic resonance imaging (MRI) scans, and arthroscopic surgery are commonplace today, but they did not exist until the 1970s. Although such new technology sometimes allows health care providers to introduce less-invasive and less-expensive treatments, more often it provides new but expensive ways to treat conditions that were previously untreatable.
Increased use of health care has also led to a growth in health care costs. Americans are more likely than ever to seek professional health services for medical problems. Many Americans today seek medical care for treatment of sexual impotence, attention-deficit hyperactivity disorder, and other problems that previously were not always considered health problems. Just as increased demand pushes prices up in other industries, increased demand for health care leads to escalating medical costs.
TEXT 4
MEDICARE AND MEDICAID
Medicare and Medicaid are programs of medical care for the aged and for the needy, respectively, in the United States. These programs are under the direction of the United States Department of Health and Human Services.
Medicare is the popular name for the federal health insurance program for persons 65 years of age and over. The program went into effect in 1966. Benefits are divided into two parts: (1) a basic hospital-insurance plan covering hospital care, extended care, home health services, and hospice care for terminally ill patients; and (2) a voluntary medical-insurance program covering physicians' fees, outpatient services, and other medical services. Medicare costs are met by social security contributions, monthly premiums from participants, and general revenues.
Beginning in July 1973 Medicare was extended to persons under the age of 65 with certain disabling conditions. In 1988 Congress passed legislation to expand the program to cover health care costs of catastrophic illnesses, to be financed by a surtax on the incomes of taxpayers over the age of 65; this legislation, however, was repealed the following year.
Modernize and Reform Medicare
Following Congressional passage of Medicare in 1965, President Lyndon Johnson said: "No longer will older Americans be denied the healing miracle of modern medicine." Yet today, in many ways, Medicare no longer keeps pace with modern medical advances. Although Medicare coverage of preventive care services has been significantly expanded over the past five years, Medicare still offers a benefit package based on the most popular Blue Cross/Blue Shield package of President Johnson's era, a standard of excellence at the time that is inadequate today. And for many seniors, Medicare does not offer coverage choices that many of the privately insured have become accustomed to receiving. One of the largest flaws in Medicare coverage today is its failure to cover outpatient prescription drugs. Approximately 98 percent of private health insurance plans offer a prescription drug benefit or a cap on out-of-pocket expenses as an integral part of the benefit package. Private health insurers recognize the important role of drug therapy in medical care. Drugs can often be cost-effective therapies preventing the need for more expensive hospitalizations or other intensive therapies.
The need for Medicare reform does not relate only to the financial condition of Medicare or the lack of adequate coverage. Of perhaps equal concern is the complexity and inflexibility of the Medicare bureaucracy itself. The current system, with ever increasing pages of regulations, administrative guidelines and other endless directives issued on a monthly basis, leaves providers and beneficiaries often bewildered and frustrated. The current system is too complex, too centralized, and becoming more so each year. Burdensome regulations and other central directives force providers to take time away from patients to comply with excessive and complex paperwork. Excessive administrative complexity also makes Medicare prone to fraud and abuse. It is often difficult to determine where honest mistakes end and fraud begins.
Sustaining the Medicare program for future generations of beneficiaries will require an honest and forthright effort by the Federal Government to address these problems. This will include employing every strategy appropriate to enhance quality health care options for beneficiaries rather than relying on increasingly punitive regulations, arbitrary and multiple pricing systems, and delays to maintain the status quo.
Today, Medicare covers only 53 percent of the average senior's annual medical expenses. The current Medicare program is burdened by horrific bureaucratic complexity and operates in a noncompetitive, inefficient manner. In addition, the program lacks the flexibility to operate differently.
Medicare fails today's elderly patients in other ways:
The preventive care services offered under Medicare, while greatly expanded, are still insufficient to help seniors remain healthy, and therefore avoid more expensive care later;
Routine services such as annual physicals, vision tests and hearing aids are not covered;
It is not coordinated with the employment-based health insurance system, providing disincentives to continued work;
It has a fee-for-service cost-sharing structure that still leaves seniors vulnerable to high costs, and is less effective than necessary in ensuring good use of care; and
It currently maintains separate trust funds, one for inpatient hospital and post-acute care, and one for physician fees and other outpatient costs. This separation may lead to misleading assessments of Medicare's financing and reflects a different era of medicine.
In addition to the way Medicare fails to provide the care seniors deserve, there is irrefutable evidence that Medicare's finances are headed for bankruptcy.
Medicare's long term financing is driven by the significant demographic trends that will begin taking shape in about 10 years.
Between 2010 and 2030, the number of persons age 65 and older will increase from 39.7 million to 69.1 million. That's an average of one and a half million more seniors per year for 20 years.
During that same period, the Medicare actuaries project Medicare spending will increase from $324 billion to $694 billion, in constant 2000 dollars.
This shift in demographics will begin with retirement of the baby boom, but it will not end there.
The great advances in health and well-being of the 20th Century will lead to significant increases in the average life span in the 21st Century.
Demographers now project that persons born in 2000 will live, on average, to age 76, up almost six years compared to people born in 1970.
As a result, there is projected to be a permanent shift in the ratio of workers to Medicare beneficiaries, from 4.0 workers today to 2.3 in 2030 and 2.0 in 2070.
These demographic trends will dramatically change spending for both social security and Medicare, but the problem is likely to be even more pronounced in Medicare due to the expected increases in health care costs per beneficiary. Medicare per capita spending is projected to vastly outpace the consumer price index for the next 25 years.These demographic trends are impacting the Medicare program as a whole, making it critical to focus on the solvency of Medicare in its entirety.
A full assessment of Medicare's finances reveals spending exceeds the total of tax receipts and premiums dedicated to Medicare today, and that "financing gap" is projected to widen dramatically. This gap was $51 billion in 2000, growing to $216 billion (using constant dollars) in 2020, and $368 billion in 2030. Not only is there no surplus in Medicare today, there is a large deficit.
Even without the large financing problem, Medicare modernization would be necessary to ensure beneficiaries get high quality health care. But the looming financial shortfall makes reform even more urgent. To be successful, reform must substantially improve Medicare's long-term financing.
Medicaid
Medicaid, a federal-state program, is usually operated by state welfare or health departments. Medicaid furnishes at least five basic services to needy persons: inpatient hospital care, outpatient hospital care, physicians' services, skilled nursing-home services for adults, and laboratory and X-ray services. The people who are eligible include families and certain children who qualify for public assistance and may include aged, blind, and disabled adults who are eligible for the Supplemental Security Income program of the Social Security Administration. States may also include persons and families termed "medically needy" who meet eligibility requirements except those for financial assistance. Each state decides who is eligible for Medicaid benefits and what services shall be included. Some of the benefits frequently provided are dental care; ambulance services; and the cost of drugs, eyeglasses, and hearing aids.
TEXT 5