Particularidades da Língua Inglesa: FAME-MG–2010 – Texto para as questões 01 até 06
Chronic conditions crank up health costs
CHARLOTTESVILLE, Va. — Raymond Harris is only 54, but he already has gone through three kidneys.
Like most people, Harris was born with two working kidneys. He lost one at age 8 because of a fall. He lost the second to high blood pressure at 42. He lost the third – donated by his wife – at age 48, because of a rare reaction to a dye that doctors used to view the blockages in his arteries. And while Harris gets a lot of health care, he isn’t exactly healthy. He has had three back surgeries and six heart attacks and depends on dialysis to survive. If medications fail to clear his arteries, he may need open-heart surgery. And less than one month after his latest heart attack, Harris is back in the emergency room at the University of Virginia Medical Center with chest pain.
While Harris’ health problems may seem extraordinary, doctors say that many Americans today appear destined to share his fate. Nearly half of Americans have a chronic condition, and 75% of the $2.6 trillion spent annually on health care goes to treat patients with long-term health problems, says Kenneth Thorpe, a professor at Atlanta’s Emory University and head of the Partnership to Fight Chronic Disease. In the Medicare program, which pays for Harris’ care because of his kidney failure, 95% of spending is linked to a chronic disease. “All of these diseases are accumulations of what’s happened before in a person’s life,” says Barbara Starfield, professor of public policy at Johns Hopkins University in Baltimore. “We have to think about keeping people as healthy as possible so they don’t get these diseases.”
Doctors say Harris’ story is filled with missed opportunities to avoid disease, but also illustrates possibilities for change – both through healthier lifestyles and more coordinated primary care – that could reduce suffering and unnecessary costs. “It would have been nice to catch him in his 20s and get him to stop smoking,” says Robert O’Connor, professor and chair of emergency medicine at the University of Virginia, who treated Harris in the ER. “I suspect he had high blood pressure back then. […] I can’t help but wonder if that would have provided a better outcome for him.”
Although health officials have exhorted Americans for years to get in shape, two thirds of adults today are overweight. But insurance plans could help in other ways, such as by covering smoking-cessation classes and other services with well-documented health benefits, says Ted Epperly, president of the American Academy of Family Physicians.
Harris gave up tobacco on his own last month after his last heart attack, after smoking a pack a day for decades. Now, he puts $5 a day in a jar – the amount he used to spend on cigarettes – and will use the savings to help pay his mortgage. “It would save a lot of money,” he says. “These health problems are going to cost them way more than the classes.”
Primary care shortage
Harris has lots of company in the ER this day. Doctors will have seen nearly 200 patients before it’s over. When the ER runs out of rooms, doctors will treat patients on gurneys in the hallway. “We don’t have a robust primary care system, so that we can’t get all of these people taken care of in the right place at the right time by the right type of doctor,” Epperly says.
Uninsured patients aren’t the only ones using the ER for non-urgent care. With too few primary care doctors to go around, many patients turn to the ER when they can’t get an appointment with their regular physician, says Sandra Schneider, president of the American College of Emergency Physicians.
In some ways, insurance payments contribute to the shortage, Epperly says, by discouraging physicians from going into primary care. Medicare, which covers people over 65, pays doctors far more to perform procedures than to monitor a patient’s overall health, Epperly says. In the past decade, only 10% of new doctors – who graduate from medical school with an average of $140,000 in student loans — have gone into primary care, Epperly says. “We have a terribly perverse incentive system,” says Stuart Butler, a health analyst and vice-president for domestic research with the Heritage Foundation in Washington.
Patients with chronic conditions may see specialists who each treat a different symptom or deteriorating organ. But these doctors may rarely if ever get together to talk about the patient’s overall health, Starfield says. […]
Medicaid, which covers poor children and the disabled, also discourages doctors from taking on new patients. The federal program, which is run by the states, pays doctors an average of 28% less than Medicare, says David Tayloe, president of the American Academy of Pediatrics. So many doctors refuse to treat patients on Medicaid. […]
A program that works
Successful regional programs could serve as models for national health care reform, says Tayloe, who practices in rural Goldsboro, N.C. North Carolina, for example, saves $150 million a year through a “visionary” Medicaid program, he says.
The plan encourages doctors to accept Medicaid patients by paying extra monthly fees that reflect the level of sickness of their patients, Tayloe says. A community health network gets an extra fee to coordinate patient care and make sure that kids stay healthy.
In the Seattle area, Group Health Cooperative experimented with a “patient-centered medical home,” which allows doctors to see fewer patients but spend more time coordinating their care. Patients in the new program had 29% fewer ER visits and 11% fewer hospitalizations, according to a study published in the American Journal of Managed Care last week. The program paid for itself within a year. […]
Several proposals for health reform could help, too, Tayloe says. A bill in the House of Representatives would improve payment for primary care doctors who see Medicare and Medicaid patients, raising Medicaid rates even more significantly so that they equal those in Medicare.
Other proposals in Congress would establish a pilot program to test more “medical home” models like the one at Group Health and fund a study on ways to balance the supply of specialists and primary-care providers. Doctors on “community health teams” would be paid to oversee patients’ care. The teams would include nurse practitioners and physician assistants – who can handle many primary care needs more cheaply than doctors – as well as dietitians, mental health counselors and others.
Such programs don’t always save money. But transforming primary care could help the country to spend its money more wisely, says Ann O’Malley of the Center for Studying Health System Change in Washington. Right now, she says, Americans spend far more on health care than most other Western countries, but have “much, much worse outcomes.” “The goal,” she says, “is to get better value for the health care dollars we’re already spending.”
SZABO, Liz. Available at: <http://www.usatoday.com/news/healt/2009-09-08-emergency-roomchronic>. Accessed: Sep. 10th, 2009. (Adapted).
01. According to the text:
A) Harris had to pay for the medical support in order to be able to do a surgery.
B) Harris’ working kidneys had to be substituted for his sister’s in a surgery.
C) Harris was born healthy and as time went by he turned out to lose his condition.
D) Harris was facing the surgeries nicely but he had a heart attack in the ER.
02. The next step for the health programs is to:
A) make worth each penny that might be necessary to cost them.
B) raise the paid value so as to make the programs more effective.
C) treat the patients in their houses and then in the ERs of the USA hospitals.
D) change the conceptions ER doctors might have about what a chronic patient is.
Particularidades da Língua Inglesa: 03. “Primary care shortage” means the:
A) insurance companies make the assistance.
B) system is going under considerable decrease nowadays.
C) government of the USA is trying to enhance the primary care attention.
D) patients in the USA hospitals have to be short age to access the primary care.
04. “The federal program, which is run by the states, pays doctors an average of 28% less than Medicare, says David Tayloe”. The underlined word means;
A) something that happens fast.
B) a fact that the states decide.
05. “Harris’ story is filled with missed opportunities to avoid disease” means:
A) Harris did not catch the opportunities to get the diseases and use Medicare.
B) Harris could avoid the diseases and now he cannot use Medicaid as a support.
C) many possibilities could be noticed to prevent some diseases from happening.
D) this story showed Harris regretted the opportunities for suffering from diseases.
06. “What’s happened before in a person’s life”. The verb tense of this excerpt is:
A) Simple Past tense.
B) Present Perfect tense.
C) Regular Simple Past tense.
D) Irregular Simple Past tense.
Particularidades da Língua Inglesa: UFOP-MG–2008 – Texto para as questões 07 até 10
Fact or fiction
Do you really need seven hours of sleep?
Yep, you do. Although people do vary in how much sleep they need, the differences are slight, and the vast majority of us (including seniors) need seven to eight hours. Most people who regularly get less than seven hours of rest are simply unaware of the damage that fatigue and sleepiness is doing to their bodies. Chronic “short-sleepers,” as scientists call them, have forgotten what it feels like to be well-rested, says Robert Rosenberg, medical director of the Sleep Disorders Center of Prescott Valley, in Arizona.
The evidence indicates that a person who regularly sleeps less than seven hours a night functions as badly as someone who hasn’t slept for one to three days, according to a research review published in the Journal of Clinical Sleep Medicine last year. Furthermore, the largest current longitudinal studies (one involving 21,268 people and another 10,308) showed that sleep-deprivation increased mortality: the chance of dying younger than people of the same age, gender and health-risk factors. In the larger study researchers at the Finnish Institute of Occupational Health assessed the sleep habits of the group in 1975 and 1981 and then checked to see
who was still alive on Dec. 31, 2003. After comparing subjects’ survival rates to the average for people of the same age (and adjusting for other known death risks, like smoking), the researchers concluded that lack of sleep increased mortality in the study participants by 26 percent for men and 21 percent for women. The cause of death might be accidents, or diseases exacerbated by sleep-deprivation. Other current research indicates that lack of sleep affects the body’s hormones, immune system and metabolism; hence, it can be a risk factor for obesity, diabetes and heart disease.
EHRENFELD, Temma. Available at: <http://www.newsweek.com/id/113270>. Accessed: Feb. 20, 2008. (Adapted).
07. Researchers concluded that sleep-deprivation:
A) must be recommended for old people.
B) may cause no impact in death rates.
C) improves the quality of life of everyone.
D) can be riskier for men than for women.
08. The information we can infer from the text is that:
A) the research reviews discussed are incomplete.
B) the larger research involved just a group of women.
C) the studies involved over thirty thousand people.
D) the stated results have no scientific basis.
09. Seven to eight hours of sleep a night is:
A) too much for students.
B) the least for most people.
C) very little for children.
D) a lot for old people.
10. “Short-sleepers” are people who sleep:
A) less than 7 hours a night.
B) during the work.
C) just at night.
D) all the time.
Particularidades da Língua Inglesa: UFOP-MG–2008 – Texto para as questões 11 até 13
Diabetes: A “disease of poverty”?
Diabetes kills as many as Aids, and is a big problem in poor countries. Dr. Martin Silink, head of the International Diabetes Federation, spoke with Mary Carmichael. I thought diabetes was a “disease of affluence”. Not anymore – 70 percent of cases are in the developing world. When people there move to cities, their risk doubles. They’re less active and they eat fewer fruits and vegetables. The numbers are especially bad in Asia. Why? Economic development there is uncovering a genetic tendency towards diabetes. For a person of European background, the risk rises at a body-mass index of 26. But for people in Asia, it starts at 22 because they put on fat in the abdominal area. That body shape is linked to insulin resistance. How do we stop this? We can encourage healthy eating and rebuild walking and bike paths. For the 246 million who are already sick, we have to improve care to avoid complications. In the poorest countries, old-fashioned drugs are still 80 to 90 percent effective.
NEWSWEEK, July 2-9, 2007, p. 75.
11. In poor countries, diabetes kills:
A) the same number of people as Aids.
B) more people than Aids.
C) less people than Aids.
D) only people with Aids.
12. The expression “disease of affluence” means:
A) a disease of modern people.
B) a disease of old people.
C) a disease of rich people.
D) a disease of poor people.
13. Particularidades da Língua Inglesa: What can be done to avoid diabetes?
A) To provide better working facilities.
B) To encourage healthier eating habits.
C) To move to cities and be more active.
D) To double the effective drugs being used.
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