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Since Would War II considerable advances have been made in the area of health-care services. These include better access to health care (particularly for the poor and minorities), improvements in physical plants, and increased numbers of physicians and other health personnel. All have played a part in the recent improvement in life expectancy. But there is mounting criticism of the large remaining gaps in access, unbridled cost inflation, the further fragmentation of service, excessive indulgence in wasteful high-technology “gadgeteering,” and a breakdown in doctor-patient relationships. In recent years proposed panaceas and new programs, small and large, have proliferated at a feverish pace and disappointments multiply at almost the same rate. This has led to an increased pessimism—“everything has been tried and nothing works”—which sometimes borders on cynicism or even nihilism.

It is true that the automatic “pass through” of rapidly spiraling costs to government and insurance carriers, which was set in a publicized environment of “the richest nation in the world,” produced for a time a sense of unlimited resources and allowed to develop a mood whereby every practitioner and institution could “do his own thing” without undue concern for the “Medical Commons.” The practice of full-cost reimbursement encouraged capital investment and now the industry is overcapitalized. Many cities have hundreds of excess hospital beds; hospitals have proliferated a superabundance of high-technology equipment; and structural ostentation and luxury were the order of the day. In any given day, one-fourth of all community beds are vacant; expensive equipment is underused or, worse, used unnecessarily. Capital investment brings rapidly rising operating costs.

Yet, in part, this pessimism derives from expecting too much of health care. It must be realized that care is, for most people, a painful experience, often accompanied by fear and unwelcome results. Although there is vast room for improvement, health care will always retain some unpleasantness and frustration. Moreover, the capacities of medical science are limited. Humpty Dumpty cannot always be put back together again. Too many physicians are reluctant to admit their limitations to patients; too many patients and families are unwilling to accept such realities. Nor is it true that everything has been tried and nothing works, as shown by the prepaid group practice plans of the Kaiser Foundation and at Puget Sound. In the main, however, such undertakings have been drowned by a veritable flood of public and private moneys which have supported and encouraged the continuation of conventional practices and subsidized their shortcomings on a massive, almost unrestricted scale. Except for the most idealistic and dedicated, there were no incentives to seek change or to practice self-restraint or frugality. In this atmosphere, it is not fair to condemn as failures all attempted experiments; it may be more accurate to say many never had a fair trial.

1. The author implies that the Kaiser Foundation and Puget Sound plans (lines 47-48) differed from other plans by

(A) encouraging capital investment

(B) requiring physicians to treat the poor

(C) providing incentives for cost control

(D) employing only dedicated and idealistic doctors

(E) relying primarily on public funding

2. The author mentions all of the following as consequences of full-cost reimbursement EXCEPT

(A) rising operating costs

(B) underused hospital facilities

(C) overcapitalization

(D) overreliance on expensive equipment

(E) lack of services for minorities

3. The tone of the passage can best be described as

(A) light-hearted and amused

(B) objective but concerned

(C) detached and unconcerned

(D) cautious but sincere

(E) enthusiastic and enlightened

4. According to the author, the “pessimism” mentioned at line 35 is partly attributable to the fact that

(A) there has been little real improvement in health-care services

(B) expectations about health-care services are sometimes unrealistic

(C) large segments of the population find it impossible to get access to health-care services

(D) advances in technology have made health care service unaffordable

(E) doctors are now less concerned with patient care

5. The author cites the prepaid plans in lines 46-48 as

(A) counterexamples to the claim that nothing has worked

(B) examples of health-care plans that were over-funded

(C) evidence that health-care services are fragmented

(D) proof of the theory that no plan has been successful

(E) experiments that yielded disappointing results

6. It can be inferred that the sentence “Humpty Dumpty cannot always be put back together again” means that

(A) the cost of health-care services will not decline

(B) some people should not become doctors

(C) medical care is not really essential to good health

(D) illness is often unpleasant and even painful

(E) medical science cannot cure every ill

7. With which of the following descriptions of the system for the delivery of health-care services would the author most likely agree?

(A) It is biased in favor of doctors and against patients.

(B) It is highly fragmented and completely ineffective

(C) It has not embraced new technology rapidly enough

(D) It is generally effective but can be improved

(E) It discourages people from seeking medical care

8. Which of the following best describes the logical structure of the selection?

(A) The third paragraph is intended as a refutation of the first and second paragraphs.

(B) The second and third paragraphs explain and put into perspective the points made in the first paragraph.

(C) The second and third paragraphs explain and put into perspective the points made in the first paragraph.

(D) The first paragraph describes a problem, and the second and third paragraphs present two horns of a dilemma.

(E) The first paragraph describes a problem, the second its causes, and the third a possible solution.

9. The author’s primary concern is to

(A) criticize physicians and health-care administrators for investing in techno?logically advanced equipment

(B) examine some problems affecting delivery of health-care services and assess their severity

(C) defend the medical community from charges that health-care has not improved since World War II

(D) analyze the reasons for the health-care industry’s inability to provide quality care to all segments of the population

(E) describe the peculiar economic features of the health-care industry that are the causes of spiraling medical costs

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