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
V Study the texts, translate the italicized words and expressions.
V 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 50 billion a year to run. This will rise to 69 billion by 2005.
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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 upsick 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.
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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 hasbeen 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.
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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.
