2020年09月六级第2套长篇阅读匹配原文翻译及答案

A) After years of big promises, telemedicine is finally living up to its potential. Driven by faster internet connections, ubiquitous (无处不在的) smartphones and changing insurance standards, more health providers are turning to electronic communications to do their jobs--and it's dramatically changing the delivery of healthcare.

经过多年的大肆宣传，远程医疗终于开始发挥其潜力。在更快的互联网连接、无处不在的智能手机和不断变化的保险标准的推动下，越来越多的医疗提供者转向电子通信来开展工作——这正在极大地改变医疗服务的交付方式。

B) Doctors are linking up with patients by phone, email and webcam (网络摄像头). They're also consulting with each other electronically -- sometimes to make split-second decisions on heart attacks and strokes. Patients, meanwhile, are using new devices to relay their blood pressure, heart rate and other vital signs to their doctors so they can manage chronic conditions at home. Telemedicine also allows for better care in places where medical expertise is hard to come by. Five to 10 times a day, Doctors Without Borders relays questions about tough cases from its physicians in Niger, South Sudan and elsewhere to its network of 280 experts around the world, and back again via the internet.

医生通过电话、电子邮件和网络摄像头与患者联系。他们也通过电子方式相互咨询——有时是为了在心脏病发作和中风问题上做出瞬息之间的决定。与此同时，患者使用新设备将他们的血压、心率和其他生命体征传送给医生，以便他们在家管理慢性疾病。远程医疗还允许在医疗专业知识难以获得的地方提供更好的护理。每天五到十次，无国界医生将其在尼日利亚、南苏丹等地的医生关于疑难病例的问题转发给其全球280位专家网络，并通过互联网传回。

C) As a measure of how rapidly telemedicine is spreading, consider: More than 15 million Americans received some kind of medical care remotely last year, according to the American Telemedicine Association, a trade group, which expects those numbers to grow by 30% this year.

作为衡量远程医疗传播速度的一个指标，考虑一下：根据美国远程医疗协会（一个贸易团体）的数据，去年有超过1500万美国人接受了某种远程医疗服务，该协会预计今年这些数字将增长30%。

D) None of this is to say that telemedicine has found its way into all corners of medicine. A recent survey of 500 tech-savvy (精通技术的) consumers found that 39% hadn't heard of telemedicine, and of those who haven't used it, 42% said they preferred in-person doctor visits. In a poll of 1 500 family physicians, only 15% had used it in their practices but 90% said they would if it were appropriately reimbursed (补偿).

这并不是说远程医疗已经渗透到医学的各个角落。最近对500名精通技术的消费者进行的一项调查发现，39%的人没有听说过远程医疗，而在那些没有使用过的人中，42%表示他们更喜欢面对面的医生访问。在一项对1500名家庭医生的民意调查中，只有15%在他们的实践中使用过它，但90%表示如果得到适当的补偿，他们会使用。

E) What's more, for all the rapid growth, significant questions and challenges remain. Rules defining and regulating telemedicine differ widely from state to state. Physicians groups are issuing different guidelines about what care they consider appropriate to deliver and in what form.

此外，尽管增长迅速，但重大的问题和挑战仍然存在。定义和监管远程医疗的规则因州而异。医生团体正在发布不同的指南，关于他们认为适合以何种形式提供何种护理。

F) Some critics also question whether the quality of care is keeping up with the rapid expansion of telemedicine. And there's the question of what services physicians should be paid for: Insurance coverage varies from health plan to health plan, and a big federal plan covers only a narrow range of services. Telemedicine's future will depend on how and whether regulators, providers, payers and patients can address these challenges. Here's a closer look at some of these issues:

一些批评者还质疑护理质量是否跟上了远程医疗的快速扩张。还有一个问题是医生应该为哪些服务获得报酬：保险覆盖范围因健康计划而异，一个大型联邦计划只覆盖有限的服务范围。远程医疗的未来将取决于监管机构、提供者、支付者和患者如何以及是否能够应对这些挑战。以下是对其中一些问题的更仔细审视：

G) Do patients trade quality for convenience? The fastest-growing services in telemedicine connect consumers with clinicians they've never met for a phone, video or email visit-on-demand, 24/7. Typically, these are for nonemergency issues such as colds, flu, ear-aches and skin rashes, and they cost around $45, compared with approximately $100 at a doctor's office, $160 at an urgent care clinic or $750 and up at an emergency room.

患者是否以质量换取便利？远程医疗中增长最快的服务将消费者与他们从未见过的临床医生连接起来，进行电话、视频或电子邮件访问，全天候按需服务。通常，这些服务用于非紧急问题，如感冒、流感、耳朵痛和皮疹，费用约为45美元，相比之下，在医生办公室约100美元，在紧急护理诊所约160美元，在急诊室750美元以上。

H) Many health plans and employers have rushed to offer the services and promote them as a convenient way for plan members to get medical care without leaving home or work. Nearly three quarters of large employers will offer virtual doctor visits as a benefit to employees this year, up from 48% last year. Web companies such as Teladoc and American Well are expected to host some 1.2 million such virtual doctor visits this year, up 20% from last year, according to the American Telemedicine Association.

许多健康计划和雇主急于提供这些服务，并将它们宣传为计划成员无需离开家或工作即可获得医疗保健的便捷方式。今年，近四分之三的大型雇主将提供虚拟医生访问作为员工福利，高于去年的48%。根据美国远程医疗协会的数据，Teladoc和American Well等网络公司预计今年将举办约120万次此类虚拟医生访问，比去年增长20%。

I) But critics worry that such services may be sacrificing quality for convenience. Consulting a random doctor patients will never meet, they say, further fragments the health-care system, and even minor issues such as upper respiratory (上呼吸道的) infections can't be thoroughly evaluated by a doctor who can't listen to your heart or feel your swollen glands. In a recent study, researchers posing as patients with skin problems sought help from 16 telemedicine sites with unsettling results. In 62 encounters, fewer than one-third disclosed clinicians' credentials or let patients choose; only 32% discussed potential side effects of prescribed medications. Several sites misdiagnosed serious conditions, largely because they failed to ask basic follow-up questions, the researchers said. "Telemedicine holds enormous promise, but these sites are just not ready for prime time, " says Jack Resneck, the study's lead author.

但批评者担心，此类服务可能以牺牲质量换取便利。他们说，咨询患者永远不会再见到的随机医生，进一步使医疗保健系统碎片化，即使是上呼吸道感染等小问题，也无法由无法听心脏或触摸肿胀腺体的医生彻底评估。在最近的一项研究中，研究人员假扮有皮肤问题的患者向16个远程医疗网站寻求帮助，结果令人不安。在62次接触中，只有不到三分之一披露了临床医生的资质或让患者选择；只有32%讨论了处方药的潜在副作用。研究人员说，几个网站误诊了严重疾病，主要是因为他们没有提出基本的后续问题。杰克·雷斯尼克，该研究的首席作者，说：“远程医疗前景巨大，但这些网站尚未准备好迎接黄金时代。”

J) The American Telemedicine Association and other organizations have started accreditation (鉴定) programs to identify top-quality telemedicine sites. The American Medical Association this month approved new ethical guidelines for telemedicine, calling for participating doctors to recognize the limitations of such services and ensure that they have sufficient information to make clinical recommendations.

美国远程医疗协会和其他组织已经启动了鉴定计划，以识别高质量的远程医疗网站。美国医学会本月批准了远程医疗的新伦理指南，呼吁参与的医生认识到此类服务的局限性，并确保他们有足够的信息来提出临床建议。

K) Who pays for the services? While employers and health plans have been eager to cover virtual urgent care visits, insurers have been far less willing to pay for telemedicine when doctors use phone, email or video to consult with existing patients about continuing issues. "It's very hard to get paid unless you physically see the patient," says Peter Rasmussen, medical director of distance health at the Cleveland Clinic. Some 32 states have passed "parity" (等同的) laws requiring private insurers to reimburse doctors for services delivered remotely if the same service would be covered in person, though not necessarily at the same rate or frequency. Medicare lags further behind. The federal health plan for the elderly covers a small number of telemedicine services only for beneficiaries in rural areas and only when the services are received in a hospital, doctor's office or clinic.

谁为这些服务付费？虽然雇主和健康计划一直急于覆盖虚拟紧急护理访问，但当医生使用电话、电子邮件或视频咨询现有患者关于持续问题时，保险公司远不愿意为远程医疗付费。克利夫兰诊所远程健康医疗主任彼得·拉斯穆森说：“除非你亲自见到患者，否则很难获得报酬。”大约32个州通过了“等同”法律，要求私人保险公司报销远程提供的服务，如果相同服务在面对面时会被覆盖，但不一定以相同的速率或频率。医疗保险进一步落后。针对老年人的联邦健康计划只覆盖少数远程医疗服务，仅限于农村地区的受益人，并且只有当服务在医院、医生办公室或诊所接受时。

L) Bills to expand Medicare coverage of telemedicine have bipartisan (两党的) support in Congress. Opponents worry that such expansion would be costly for taxpayers, but advocates say it would save money in the long run.

扩大医疗保险覆盖远程医疗的法案在国会得到了两党的支持。反对者担心这种扩大会对纳税人来说成本高昂，但倡导者说从长远来看会节省资金。

M) Experts say more hospitals are likely to invest in telemedicine systems as they move away from fee for-service payments and into managed-care-type contracts that give them a set fee to provide care for patients and allow them to keep any savings they achieve.

专家表示，随着医院从按服务收费转向托管式合同，为提供患者护理支付固定费用并允许它们保留所实现的任何节省，更多的医院可能会投资远程医疗系统。

N) Is the state-by-state regulatory system outdated? Historically, regulation of medicine has been left to individual states. But some industry members contend that having 50 different sets of rules, licensing fees and even definitions of "medical practice" makes less sense in the era of telemedicine and is hampering its growth. Currently, doctors must have a valid license in the state where the patient is located to provide medical care, which means virtual-visit companies can match users only with locally licensed clinicians. It also causes administrative hassles (麻烦) for world-class medical centers that attract patients from across the country. At the Mayo Clinic, doctors who treat out-of-state patients can follow up with them via phone, email or web chats when they return home, but they can only discuss the conditions they treated in person. "If the patient wants to talk about a new problem, the doctor has to be licensed in that state to discuss it. If not, the patient should talk to his primary-care physician about it, " says Steve Ommen, who runs Mayo's Connected Care program.

逐州监管系统是否过时？历史上，医学的监管留给了各个州。但一些行业成员认为，在远程医疗时代，拥有50套不同的规则、许可费甚至“医疗实践”的定义意义不大，并阻碍了其发展。目前，医生必须在患者所在州拥有有效的执照才能提供医疗服务，这意味着虚拟访问公司只能将用户与本地许可的临床医生匹配。这也为吸引全国各地患者的世界级医疗中心带来了行政麻烦。在梅奥诊所，治疗州外患者的医生可以在患者回家后通过电话、电子邮件或网络聊天与他们跟进，但只能讨论他们亲自治疗的疾病。史蒂夫·奥门，运营梅奥的Connected Care计划，说：“如果患者想讨论一个新问题，医生必须在该州获得许可才能讨论。如果没有，患者应该与他的初级保健医生讨论。”

O) To date, 17 states have joined a compact that will allow a doctor licensed in one member state to quickly obtain a license in another. While welcoming the move, some telemedicine advocates would prefer states to automatically honor one another's licenses, as they do with drivers' licenses. But states aren't likely to surrender control of medical practice, and most are considering new regulations. This year, more than 200 telemedicine-related bills have been introduced in 42 states, many regarding what services Medicaid will cover and whether payers should reimburse for remote patient monitoring. "A lot of states are still trying to define telemedicine, " says Lisa Robbin, chief advocacy officer for the Federation of State Medical Boards.

迄今为止，已有17个州加入了一项协议，允许在一个成员州获得许可的医生快速在另一个州获得许可。虽然欢迎这一举措，但一些远程医疗倡导者希望各州自动互相承认执照，就像他们对驾驶执照所做的那样。但各州不太可能放弃对医疗实践的控制，大多数正在考虑新的法规。今年，42个州引入了200多项与远程医疗相关的法案，许多关于医疗补助将覆盖哪些服务以及支付者是否应该报销远程患者监测。丽莎·罗宾，州医学委员会联合会的首席倡导官，说：“许多州仍在试图定义远程医疗。”