Victory for the ACT Student Text 15e

154 • R EADING

Passage III SOCIAL SCIENCE: This passage discusses the history of hospitals. 50 Public general hospitals originated in ƒŽ•Š‘—•‡ ‹ϐ‹”ƒ”‹‡•Ǥ •–ƒ„Ž‹•Š‡† ƒ• ‡ƒ”Ž› ƒ•…‘Ž‘‹ƒŽ –‹‡•ǡ –Š‡•‡ ‹ϐ‹”ƒ”‹‡• ™‡”‡ created by local governments to care for the poor. Later, in the late eighteenth and ‡ƒ”Ž› ‹‡–‡‡–Š…‡–—”‹‡•ǡ –Š‡ ‹ϐ‹”ƒ”› separated from the almshouse and became an independent institution supported by local tax money. At the same time, private charity hospitals began to develop. Both private and public hospitals mainly provided food and shelter for the impoverished sick. There was little that medicine could actually do to cure illness, and the middle class was treated at home by private physicians. Late in the nineteenth century, private charity hospitals began trying to attract middle-class patients. Although the depression of 1890 stimulated the growth of charitable institutions and an expanding urban population became dependent on assistance, there was a decline in private contributions to these organizations. This decline forced –Š‡ –‘ Ž‘‘ –‘ Ž‘…ƒŽ ‰‘˜‡”‡– ˆ‘” ϐ‹ƒ…‹ƒŽ support. Since private institutions had also lost benefactors, they began to charge patients. In order to attract middle-class patients, private institutions provided services and amenities that distinguished between paying and nonpaying patients, making the hospital a desirable place for private physicians to treat their own patients. As paying patients became more necessary to the survival of the private hospital, the public hospitals slowly became the only place for the poor to get treatment. By the end of the nineteenth century, cities were reimbursing private hospitals for their care of indigent patients. The public hospitals remained dependent on tax dollars. The advent of private hospital health insurance gave middle-class patients the power to pay for private hospital services and guaranteed the private hospital a regular source of income. Private hospitals could restrict themselves to revenue-generating patients while the public hospitals were left to care for the poor. Although public hospitals continued to provide outpatient services, emergency services, and services for patients ™‹–Š…‘–ƒ‰‹‘—• †‹•‡ƒ•‡•ǡ –Š‡ Ž—‡ ”‘•• ’Žƒ• 5 10 15 20 25 30 35 40 45

developed around the needs of the private hospitals and the inpatients they served. Thus, reimbursement for ambulatory care has „‡‡ ‹‹ƒŽ —†‡” ‘•– Ž—‡ ”‘•• ’Žƒ•Ǥ Provision of outpatient care has not been a major function of the private hospital, in part because private patients can afford to pay for the services of private physicians. Also, since ‘”Ž† ƒ” ǡ –Š‡”‡ Šƒ• „‡‡ ƒ Š—‰‡ ‹ϐŽ—š ‘ˆ federal money into private medical schools and their hospitals. Further, large private medical centers with expensive research equipment and programs have attracted the best administrators, physicians, and researchers. Because of the greater resources available to the private medical centers, it is harder for ’—„Ž‹…Š‘•’‹–ƒŽ• –‘ ƒ––”ƒ…– Š‹‰ŠŽ› “—ƒŽ‹ϐ‹‡† research and medical personnel. With the ƒ‹•–”‡ƒ ‘ˆ Š‡ƒŽ–Š…ƒ”‡ ϐ‹”Ž› ‡•–ƒ„Ž‹•Š‡† ‹ the private medical sector, the public hospital has become a “dumping ground.” 55 60 65 70 16. In line 38, the word indigent most nearly means: F. without the means to pay. G. having emergency medical needs. H. lacking health insurance. J. reimbursed by the government. 17. ……‘”†‹‰ –‘ –Š‡ ’ƒ••ƒ‰‡ǡ –Š‡ ˜‡”› ϐ‹”•– private hospitals: A. developed from almshouse ‹ϐ‹”ƒ”‹‡•Ǥ B. provided better care than public ‹ϐ‹”ƒ”‹‡•Ǥ Ǥ ™‡”‡ ‡•–ƒ„Ž‹•Š‡† ƒ‹Ž› –‘ •‡”˜‹…‡ –Š‡ poor. D. were supported by government revenues. 18. It can be inferred that the author believes the differences that currently exist between public and private hospitals are primarily the result of: F. political considerations. G. economic factors. H. ethical concerns. J. legislative requirements.