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1、Section1Questions1-11arebasedonthefollowingpassage.ThispassageisadaptedfromAtulGrover,“ShouldHospitalResidencyProgramsBeExpandedtoIncreasetheNumberofDoctors?”©2013DowJones&Company.45/45Thankstobabyboomers,thepopulationover65willhavedoubledbetween2000and2030.AndwhentheAffordableCareA
2、cttakesfulleffect,upto32millionnewpatientswillseekaccesstomedicalcare,manyofwhomwillneedtreatmentforailmentsthathavegoneundiagnosedforyears,suchascancer,diabetes,arthritisandheartdisease.ThissurgeindemandmeanstheU.S.willhaveashortfallofatleast90,000doctorsbytheendofthedecade,accordi
3、ngtotheAssociationofAmericanMedicalCollegesCenterforWorkforceStudies.Manypartsofthecountryhavetoofewdoctorsalready.Asmall,vocalminorityofresearcherssuggestwedon'tneedmoredoctors.Thatminorityclearlyishavinganimpact:manycliniciansandpolicymakerssaythereis20%to30%"waste"inourhealth-car
4、esystem.ElliottFisher,aDartmouthprofessor,saysthosenumbersarebackedupbyDartmouthresearch.TheDartmouthstudiesbasetheirconclusionsaboutwasteoncomparisonsofhealth-carespendingindifferentgeographicareas.Butotherstudieshaveshownthatdifferencesinthehealthstatusofpatientsinthedifferentregi
5、onsexplainthemajorityofvariationsinspending.Inotherwords,urbanareas,withtheirhighconcentrationsofpoorpeople,tendtohaveahigherdiseaseburdenandthushighermedicalneeds.Sickerpatients,alongwithhighlaborcosts,explainthehigherlevelsofspendingfoundintheseurbanareas—nottoomanydoctors.Thereis
6、noquestionthatdeliveryofcareneedstobebetterorganized,andthatsomecurrentreformsarelikelytoimprovepatientoutcomes.That'strue,forexample,withexperimentsinteam-basedcare.However,theseimprovementsinpatientcarehavenottranslatedtoanyreductionintheneedforphysiciantime.Anothernewexperiment–a
7、ccountable-careorganizations,whichallowgroupsofproviderstoshareanysavingsgainedbykeepingtheirpatientshealthy–alsohasn'tbeenshowntoreducethenumberofphysiciansneeded.Indeed,thereisalotofwishfulthinkingassociatedwithACOs,justasthere45/45waswithHMOs1inthe1990s—thateveryonewouldbecaredfo
8、rinawaythatwouldcos
