Министерство образования Российской Федерации
Дальневосточный государственный университет
Восточный институт
Health Services in the usa
Лабораторная работа
по английскому языку
для студентов IV курса Восточного института
Владивосток
Издательство Дальневосточного университета
2001
ББК81.2
УДК 802. 0: 910 (076.5)
Данная лабораторная работа предназначена для студентов IV курса и является продолжением вышедшей в 1999 году работы «Здравоохранение в Великобритании». Целью данной работы является овладение студентами лексики по данной теме. Комплекс упражнений, представленных в работе, способствует активному усвоению лексики, расширяет словарный запас, закрепляет навыки устной речи и обеспечивает их дальнейшее развитие.
Подготовлена на кафедре английского языка Восточного института ДВГУ.
Составители: Н.Г.Зверева, В.В.Горбенко, И.В.Нагиба, О.И. Сурожская.
Печатается по решению учебно-методического совета ДВГУ.
© Издательство Дальневосточного института, 2001
Introductory Text
In the final decades of the 20 century, Americans increasingly view good health as something to which they have a right. They believe they have a right to good health because widespread advances in medical research have made it possible to treat many previously "untreatable" diseases, and because the constitutional responsibility of the American government to "promote the general Welfare" is far more broadly interpreted today than it has been in the past. These rising expectations regarding health care in the United States are a result of vastly increased medical knowledge; and the belief that in an affluent and democratic society all people should have access to well-trained physicians, fully equipped hospitals and highly sophisticated procedures for the treatment of disease.
Text 1: Health Care System in the USA
The United States today has evolved a mixed system of private and government responsibility for health care. While private citizens and health insurance companies spent about 230 thousand million dollars on health care in 1986, federal, state and local governments spent 179 thousand million dollars for medical services of all kinds. Public funds financed much of the research on the artificial heart, but it was a private corporation, Humana, which paid for artificial heart surgery and patient care. This interchange between the public and private sectors is typical of how the United States provides many kinds of health and medical services.
How do most Americans pay their medical bills? For the vast majority, the answer is medical insurance. About five out of every six workers, along with their families, are covered by group health insurance plans, paid for jointly by the employer and employee or by the employee alone. Under the most common type of health plan, the individual pays a monthly premium, or fee. Typically, employees who wish more extensive medical coverage will choose a plan requiring higher premiums.
In return, the insurance company covers most major medical costs, except for a minimum amount, called the "deductible", which the employee pays each year before insurance coverage begins. Benefits then cover a certain percentage, often 80 percent, of the patient's bills in excess of the deductible. Some policies provide that after the employee's bills have reached a certain amount, the insurer covers 100 percent of all additional costs.
Depending on the plan, deductible amounts on most health insurance policies range from $50 to $300. Insurance plans vary considerably, with some offering coverage for dental costs and others providing for mental health counseling and therapy.
Another type of health care plan available to many workers is a Health Maintenance organization (HMO). An HMO is staffed by a group of physicians who agree to provide all of an individual's medical care for a set fee paid in advance. HMOs emphasize preventive health care, since the organization loses money rather then gaining fees when it is necessary to prescribe treatment or place someone in the hospital. For this reason, medical experts generally credit HMOs with helping to hold down overall medical costs. In 1987, about 660 HMOs served about 29 million people.
Text 2: Medicaid and Medicare
Although most families have some form of private health insurance, some citizens cannot afford such insurance. These people receive medical coverage through two major social programs enacted in 1965.
Medicaid is a joint federal-state program which funds medical care for the poor people. The requirements for receiving Medicaid, and the scope of the medical care available, vary widely from state to state. Medicaid has proved more costly than expected, and has been exploited for unjustified gain by some physicians. As a result, the government has decreased Medicaid services by making the requirements for those entitled to participate in the program more strict. Nonetheless, Medicaid has greatly increased the use of health care services by the poor.
Medicare is a federal program financed through the Social Security Administration, which provides a national system of retirement and other benefits. Medicare pays a substantial part of the medical bills of Americans who are over 65 years or are disabled. Medicare is not a poverty program, but is rather a form of federally administered and supported health insurance. One part of Medicare covers a major portion of hospital bills for the elderly and is financed by a portion of the Social Security tax. Another part is financed by premiums paid by Medicare recipients, as well as from direct federal funds. Everyone who collects Social Security is covered by Medicare.
As is the case with the rest of the health care system in the United States, Medicare has felt the pressure of rising costs. In response, the government has taken two steps, First, Medicare has raised the amount of the deductible that patient must pay before insurance benefits begin. Second, it has changed its method of paying hospitals. Instead of paying hospitals through a vague formula called "reasonable charges", Medicare now pays according to the patient's diagnosis. This provides an incentive for the hospital to keep costs down. If, for example, the hospital can treat a patient who needs gall bladder surgery for less than Medicare pays to treat such an illness, the hospital makes a profit. If the patient's treatment costs more than Medicare pays, the hospital loses money.
In addition to controlling costs, the United States confronts the problem of those who cannot afford private health insurance and yet are not eligible for either Medicaid or Medicare. One estimate is that more than 30 million people or 1 in 7 Americans have no health insurance during at least part of the year. These may be individuals who are unemployed for a time, families close to the poverty line or those living in remote rural areas. Such individuals can go to public hospitals, where they can always receive treatment in an emergency, but they often fail to obtain routine medical care that could prevent later chronic or serious illness.
Text 3: The Physician
Self-employed private physicians who charge a fee for each patient visit are the foundation of medical practice in the United States. Most physicians have a contractual relationship with one or more hospitals in the community. They send their patients to this hospital, which usually charges patients according to the number of days they stay and the facilities - operating room, tests, and medicines - that they use. Some hospitals belong to a city, a state or, in the case of veteran's hospitals, a federal government agency. Others are operated by religious orders or other nonprofit groups. Still others operate for profit.
Some medical doctors are on salary. Salaried physicians may work as hospital staff members or residents, who often are still in training. They may teach in medical schools, be hired by corporations to care for their workers or work for the federal government's Public Health Service.
Physicians are among the best-paid professionals in the United States. In the 1980s, it is not uncommon for medical doctors to earn incomes of more than $100, 000 a year. Specialists, particularly surgeons, might earn several times that amount. Physicians list many reasons why they deserve to be so well rewarded for their work. One reason is the long and expensive preparation required to become a physician in the United States. Most would-be physicians first attend college for four years, which can cost $20, 000 annually at one of the best private institutions. Prospective physicians then attend medical school for four year. Tuition alone can exceed $10, 000 a year. By the time they have obtained their medical degrees, many young physicians are deeply in debt. They still face three to five years of residency in a hospital, the first year as an intern, an apprentice physician. The hours are long and the pay is relatively low.
Setting up a medical practice is expensive, too. Sometimes several physicians will decide to establish a group practice, so they can share the expense of maintaining an office and buying equipment. These physicians also take care of each other's patients in emergencies.
Physicians and hospitals also most buy malpractice insurance to protect themselves should they be sued for negligence by patients who feel they have been mistreated or have received inadequate care. The rates that physicians were charged for this insurance rose very steeply in the 1970s and '80s as patients became more medically knowledgeable, and as juries sometimes awarded very large amounts of money to injured patients.
Physicians work long hours and must accept a great deal of responsibility. Many medical procedures, even quite routine ones, involve risk. It is understandable that physicians want to be well awarded for making decisions which mean the difference between life and death.
Text 4: Patterns of Change
The health care system in the United States today is in a period of rapid changes on many different fronts. One example is the distribution of medical services. By the mid-1980s, the United States, in a reversal of a long-standing pattern, no longer faced a shortage of physicians. There was, in fact, a developing surplus of medical doctors. But physicians often prefer to practice in urban areas or comfortable suburbs. As a result, many inner city areas and rural communities still lack sufficient physicians and adequate medical facilities.
As the number of medical specialties has grown in recent years, patients sometimes have found it frustrating to deal with a number of different physicians for differing ailments, rather than with the traditional family physician. Medical schools have responded by creating a new specialty - family medicine. Such family physicians can diagnose and treat many kinds of illnesses, though they also send patient to specialists when necessary. Not every medical problem requires a highly trained specialist, or even a physician. In some communities, physicians' assistants, working with medical doctors, perform some routine medical procedures. Nurse midwives manage normal pregnancies and deliveries, calling upon obstetricians only if problems develop.
Another change in American medical practice is that profit-making corporations are playing an increasingly large role in providing medical care, and chains of private, "for-profit" hospitals are growing. Private companies also compete for contracts to run public hospitals for a fee, promising more efficient and cost-conscious management.
Can profit-making corporations deliver more economical and higher quality medicine? Or do they simply draw patients with sufficient funds or health insurance away from non-profit and public hospitals, leaving those institutions to cope with the poorest and sickest patients?
Liberal social critics deplore the lack of government planning and central oversight inherent in a free market approach to health care. Conservative critics, on the other hand, feel that government-funded health insurance and medical programs are inefficient and more expensive than private medical care in the long ran. Critics on both sides often agree, however, the medical profession has been given too much freedom in determining the cost of medical care.
While some groups might benefit from funds spent to improve medical care further, many people feel that differences in the way people live account for much of the health gap between rich and middle-class and the poor. Is it possible to spend too much money saving a single life? Would spending less money on advanced medical treatments increase the amounts available for better nutrition, pollution controls, safety devices, campaigns to increase exercise and cut back smoking, and other preventive measures. Should people be held responsible for habits and behaviors which make them sick?
Physicians, politicians, medical experts and ordinary citizens were debating these questions in the early 1990s. The answers are by no means clear-cut, but involve a number of trade-offs and compromises between equally desirable goals. In a nation in which more than 11 percent of the Gross National product (the value of all goods and services) is spent on medical services of all kinds, Americans are in agreement on one central point: Quality, affordable health care must be available to everyone.
Essential Vocabulary
Health care - здравоохранение
Preventive health care - профилактика заболеваний
Routine medical care - обычное медицинское обслуживание
Affordable health care - доступное здравоохранение
Health care system - система здравоохранения
Medical care - медицинское обслуживание
Private medical care - частное медицинское обслуживание
To evolve a system of health care - развивать систему здравоохранения
A health insurance company - медицинская страховая компания
A health insurance plan - вид медицинского страхования
To spend money on health - тратить деньги на здравоохранение
A health insurance policy - страховой медицинский полис
To finance research - финансировать
To pay a policy – оплачивать полис
To pay a medical bill – оплачивать расходы на лечение
A medical service – медицинская услуга
Distribution of medical services – распределение медицинских услуг
Medical practice – медицинская практика
To set up/ establish a medical practice - организовать медицинскую практику
Health Maintenance Organization (HMO) – Организация по поддержанию здоровья
To hold down overall medical costs – снижать затраты на лечение
Dental costs – стоимость стоматологических услуг
Medicaid – государственное медицинское страхование неимущих
Medicare – государственное медицинское страхование пенсионеров и инвалидов
To be eligible for – подпадать под
A premium/ fee – страховой взнос
To cover medical costs – оплачивать затраты/ расходы на лечение
Medical coverage – 1. охват медицинским обслуживанием. 2. оплата медицинских услуг.
Insurance coverage – охват страхованием, действие страховки
Under a type of health plan – по виду медицинского страхования
Deductible – остаток, исчисляемый остаток (сумма, которую необходимо уплатить до начала действия страховки)
To cover in excess of – оплачивать за исключением
Mental health counseling – психотерапевтические консультации
Therapy – психотерапия, лекарственная терапия
Therapist - психотерапевт
A physician – терапевт, врач общей практики (амер.)
A surgeon - хирург
An obstetrician – врач-акушер
Obstetrics - акушерство
A medical doctor - врач
Self-employed private physicians – врачи, обслуживающие свое собственное предприятие
Salaried physicians – врачи на ставке
An intern – интерн (амер.) врач, работающий под надзором и контролем ординатора, обычно студент, оканчивающий обучение
An internship – интернатура – курс практической подготовки в больнице до выдачи права на практическую деятельность; в России частью такого разрешения является выдача личной печати врача
A residency – резидентура (амер.) – последипломная больничная подготовка врачей, предусматривающая специализацию в течение 1 года интерном и в течение 3-5 лет резидентом
A resident physician – врач-стажер, врач-резидент (проходящий последипломную клиническую подготовку после интернатуры и обычно живущий при больнице)
An apprentice physician –врач-практикант
A nurse midwife - сестра-акушерка
An orderly - санитар
A family doctor - семейный врач
То have a contractual relationship with a hospital - иметь договорные отношения с больницей
То charge a fee for every patient visit - взимать плату за каждый визит пациента
То charge patients according to the number of days they stay -взимать плату с пациентов за количество дней, проведенных в больнице
То buy malpractice insurance - покупать страховку на случай судебного преследования врачей за врачебную ошибку
То sue for negligence - возбуждать иск о преступной халатности/небрежности
То receive inadequate care - получать некачественное обслуживание
Disabled - инвалид
Handicapped - инвалид (оба слова считаются «корректными» и употребляются вместо слова «invalid», которое считается оскорбительным)
A recipient - получатель
То diagnose - диагностировать
A diagnosis - диагноз
Poverty line - черта бедности
То run a hospital - управлять больницей
A public hospital - государственная больница
A private hospital -частная больница
A non-profit hospital - государственная больница
A public clinic - государственная поликлиника
A private clinic - частная поликлиника
A surplus of doctors - избыток врачей
То manage pregnancies - наблюдать беременность
То manage deliveries - принимать роды
Profit - making corporations - частные корпорации
A campaign to increase exercise - кампания за здоровый образжизни
A campaign to cut back smoking - кампания за сокращение курения
Additional Vocabulary
Treatment of heart diseases - лечение кардиологическихзаболеваний
To perform heart surgery - делать операцию на сердце
Heart transplant - трансплантация сердца
Artificial heart - искусственное сердце
То implant - имплантировать
То implant an artificial heart - имплантировать искусственноесердце
То scan body organs - сканировать органы тела
Ultrasound technique – УЗИ
Radiation treatment - лучевая терапия/радиотерапия
Diagnostic tests - анализы
Amniocentesis -аминоцентез (пункция плодного пузыря)
Dialysis - диализ/гемодиализ (очистка крови аппаратом
искусственной почки)
A respirator - аппарат искусственного дыхания
То administer medication - назначать медикаментозное лечение
Skin grafting technique - метод/способ пересадки кожи
Exercises