PBS高端访谈:金融激励机制促使农村医院进行更多的手术

 　　HARI SREENIVASAN: The growing popularity of critical access hospitals, small hospitals in mostly rural areas, is posing a dilemma¹ for people needing or wanting surgery.

　　For many in those areas, these hospitals may be more convenient, but a Wall Street Journal investigation² has found the risk of serious or fatal complications during major orthopedic surgery is greater there than at a general hospital.

　　Christopher Weaver³ is one of the reporters on that story. He joins me now to discuss it.

　　So, what's the problem that's happening at these hospitals?

　　金融激励机制促使农村医院进行更多的手术

　　CHRISTOPHER WEAVER, The Wall Street Journal: So, the hospitals are doing more and more of a procedure that is lucrative⁴ for almost any kind of hospital, hip⁵ and knee replacements⁷ for in-patients.

　　The problem is, they're not doing it enough more to be as good as it as bigger hospitals that have much lower rates of people dying after the surgeries.

　　HARI SREENIVASAN: Right. So, usually, you would think that, the more you do, the better you get at it, the lower complications, right?

　　CHRISTOPHER WEAVER: Sure.

　　So, the average in 2013, right, the average critical access hospital was doing about 26 of these procedures a year. It's about 130, I think, for general hospitals. The experts say that the safest hospitals do about 100.

　　And even as they are growing, right, you would think that would lead to better outcomes. But some of them are growing from two, three, five a year to like 13 or 12. And experts say that's just not enough to do them well.

　　HARI SREENIVASAN: And what are we talking about in terms of outcomes? How much more dangerous is it?

　　CHRISTOPHER WEAVER: Yes.

　　So, we asked some researchers at Harvard to help us figure that out, because you need to adjust for things, like whether patients might be sicker in rural areas or older and so forth⁸.

　　And what they found, right — and it complements⁹ our own findings — I think it was about nine in 1,000 people die within 30 days of getting one of these procedures at a critical access hospital. That is almost 80 percent more than at a typical general hospital, where the rates are about five per 1,000.

　　HARI SREENIVASAN: OK.

　　So, why are these hospitals in these critical access or these rural areas doing this and specializing in this? I mean, I think of a rural hospital, saying, OK, maybe I'm just the nuts and bolts, making sure that you are OK from a heart attack or a cold, not specifically a hip or knee replacement⁶.

　　CHRISTOPHER WEAVER: Sure.

　　So, in the late '90s, Congress set up a totally different way to pay these critical access hospitals, compared to your typical — your town memorial, right. The critical access hospitals get paid based on their costs, 101 percent of their costs by Medicare.

　　The result is that doing lucrative procedures like hip replacement results in bigger — a bigger amount of money to them than it might to a typical general hospital that gets paid a flat rate for doing each case.

　　HARI SREENIVASAN: So, what is the recourse here? Is there a way to undo¹⁰ this?

　　CHRISTOPHER WEAVER: You know, it's tough, because these places are often sort of the only hospital in a local service area.

　　And Medicare needs to balance the fact that they want people to be able to have access to emergency treatment for things like heart attacks, with their concerns, which they seem to share, right, about the kinds of patterns that we're seeing and the quality and the kinds of surgeries that the hospitals are performing.

　　You know, some experts that we have been speaking with suggest that maybe they should get this special payment only for those kinds of emergency procedures that the public would want to have there, right, and then not for perhaps elective procedures that patients might be better served to get at bigger hospitals somewhere else.

　　HARI SREENIVASAN: Christopher Weaver of The Wall Street Journal, thanks so much for joining us.

　　CHRISTOPHER WEAVER: Sure.

 

1 dilemma   

n.困境，进退两难的局面

参考例句：

• I am on the horns of a dilemma about the matter.这件事使我进退两难。
• He was thrown into a dilemma.他陷入困境。

2 investigation   

n.调查，调查研究

参考例句：

• In an investigation,a new fact became known, which told against him.在调查中新发现了一件对他不利的事实。
• He drew the conclusion by building on his own investigation.他根据自己的调查研究作出结论。

3 weaver   

n.织布工；编织者

参考例句：

• She was a fast weaver and the cloth was very good.她织布织得很快，而且布的质量很好。
• The eager weaver did not notice my confusion.热心的纺织工人没有注意到我的狼狈相。

4 lucrative   

adj.赚钱的，可获利的

参考例句：

• He decided to turn his hobby into a lucrative sideline.他决定把自己的爱好变成赚钱的副业。
• It was not a lucrative profession.那是一个没有多少油水的职业。

5 hip   

n.臀部，髋；屋脊

参考例句：

• The thigh bone is connected to the hip bone.股骨连着髋骨。
• The new coats blouse gracefully above the hip line.新外套在臀围线上优美地打着褶皱。

6 replacement   

n.取代，替换，交换；替代品，代用品

参考例句：

• We are hard put to find a replacement for our assistant.我们很难找到一个人来代替我们的助手。
• They put all the students through the replacement examination.他们让所有的学生参加分班考试。

7 replacements   

n.代替( replacement的名词复数 )；替换的人[物]；替代品；归还

参考例句：

• They infiltrated behind the lines so as to annoy the emery replacements. 他们渗透敌后以便骚扰敌军的调度。 来自辞典例句
• For oil replacements, cheap suddenly looks less of a problem. 对于石油的替代品来说，价格变得无足轻重了。 来自互联网

8 forth   

adv.向前；向外，往外

参考例句：

• The wind moved the trees gently back and forth.风吹得树轻轻地来回摇晃。
• He gave forth a series of works in rapid succession.他很快连续发表了一系列的作品。

9 complements   

补充( complement的名词复数 )； 补足语； 补充物； 补集（数）

参考例句：

• His business skill complements her flair for design. 他的经营技巧和她的设计才能相辅相成。
• The isoseismal maps are valuable complements to the instrumental records. 等震线图是仪器记录有价值的补充资料。

10 undo   

vt.解开，松开；取消，撤销

参考例句：

• His pride will undo him some day.他的傲慢总有一天会毁了他。
• I managed secretly to undo a corner of the parcel.我悄悄地设法解开了包裹的一角。