The Planning Commission asserts that the needed reduction in acute care hospital beds

can best be accomplished by closing the smaller hospital, mainly voluntary and proprietary. This strategy follows from the argument that closing entire institutions saves more money than closing the equivalent number of beds scattered throughout the health system.

The issue is not that simple. Larger hospitals generally are designed to provide more complex care. Routine care at large hospitals costs more than the same care given at smaller hospitals. Therefore, closure of all the small hospitals would commit the city to paying considerably more for inpatient care delivered at acute care hospitals than would be the case with a mixture of large and small institutions. Since reimbursement rates at the large hospitals are now based on total costs, paying the large institutions a lower rate for routine care would simply raise the rates for complex care by a comparable amount. Such a reimbursement rate adjustment might make the charges for each individual case more accurately reflect the actual costs, but there would be no reduction in total costs.

There is some evidence that giant hospitals are not the most efficient. Service organizations – and medical care remains largely a service industry – frequently find that savings of scale have an upper limit. Similarly, the quality of routine care in the very largest hospitals appears to be less than optimum. Also, the concentration of all hospital beds in a few locations may affect the access to care. Thus, simply closing the smaller hospitals will not necessarily save money or improve the quality of care.

Since the fact remains that there are too many acute care hospital beds in the city, the problem is to devise a proper strategy for selecting and urging the closure of the excess beds, however many it may turn out to be.

The closing of whole buildings within large medical centers has many of the cost advantages of closing the whole of smaller institutions, because the fixed costs can also be reduced in such cases. Unfortunately, many of the separate buildings at medical centers are special use facilities, the relocation of which is extremely costly. Still, a search should be made for such opportunities.

The current lack of adequate ambulatory care facilities raises another possibility. Some floors or other large compact areas of hospitals could be transferred from inpatient to ambulatory uses. Reimbursement of ambulatory services is chaotic, but the problem is being addressed. The overhead associated with the entire hospital should not be charged, even prorated to the ambulatory facilities. Even if it were, the total cost would probably be less than that of building a new facility. Many other issues would also need study especially the potential over centralization of ambulatory services.

(1)、This passage is mainly about ________________.

A、ways to protect small hospitals

B、methods of selecting qualified hospitals

C、solutions to the shortage of hospital beds

D、economic consideration in closing small hospitals

(2)、It seems that the author thinks that the claim made by Planning Commission is ________________.

A、fair

B、wise

C、foolish

D、shortsighted

(3)、The closure of all small hospitals would lead to ________________.

A、a reduction in total costs

B、a reduction in the number of patients

C、an increase in the cost of inpatient care

D、an increase in the number of large hospitals

(4)、The author agrees with all the following statements EXCEPT that ________________.

A、access to medical care is an important issue

B、big hospitals are not necessarily more efficient

C、large hospitals provide better and more complex care than smaller ones

D、the same routine medical care costs more at large hospitals than at smaller ones

(5)、According to the author, the best way to reduce costs in the health system is ________________.

A、to make full use of the existing facilities

B、to update the entire medical service

C、to close most giant hospitals

D、to close all small hospitals