Behind the brewing war over protecting patients' records in an age of HMOs and online medicine

　　Technology is a two-edged sword. Rarely is this as clear as it is in the realm of health care. Technology allows doctors to test their patients for genetic defects--and then to turn around and spread the results throughout the world via the Internet. For someone in need of treatment, that's good news. But for someone in search of a job or an insurance policy, the tidings can be all bad.　　
　　Last week President Bill Clinton proposed a corollary to the patients' bill of rights now before Congress: a right to medical privacy. Beginning in 2002, under rules set to become law in February, patients would be able to stipulate the conditions under which their personal medical data could be divulged. They would be able to examine their records and make corrections. They could learn who else had seen the information. Improper use of records by a caregiver or insurer could result in both civil and criminal penalties. The plan was, said Clinton, "an unprecedented step toward putting Americans back in control of their own medical records."　　
　　While the administration billed the rules as an attempt to strike a balance between the needs of consumers and those of the health-care industry, neither doctors nor insurance companies were happy. The doctors said the rules could actually erode privacy, pointing to a provision allowing managed-care plans to use personal information without consent if the purpose was "health-care operations." That, physicians said, was a loophole through which HMOs and other insurers could pry into the doctor-patient relationship, in the name of assessing the quality of care. Meanwhile, the insurers protested that the rules would make them vulnerable to lawsuits. They were especially disturbed by a provision holding them liable for privacy breaches by "business partners" such as lawyers and accountants. Both groups agreed that privacy protections would drive up the cost of health care by at least an additional $3.8 billion, and maybe much more, over the next five years. They also complained about the increased level of federal scrutiny required by the new rules' enforcement provisions.　　
　　One aim of the rules is to reassure patients about confidentiality, thereby encouraging them to be open with their doctors. Today various cancers and sexually transmitted diseases can go untreated because patients are afraid of embarrassment or of losing insurance coverage. The fear is real: Clinton aides noted that a January poll by Princeton Survey Research Associates found that one in six U.S. adults had at some time done something unusual to conceal medical information, such as paying cash for services.　　　　　　
　　注(1)：本文选自By EVAN THOMAS Newsweek; 11/08/99, Vol. 134 Issue 19, p67, 1/2p, 1c
　　　
　　1. The author begins his article with “technology is a two-edged sword” to _____________.
　　[A] show that doctor’s improper use of technology can end up in bad results
　　[B] call on people’s attention to the potential danger technology can bring to us
　　[C] warn of the harm patients are prone to suffer
　　[D] show the advantages and disadvantages of technology
　　
　　2. According to the proposal made by President Clinton, patients will be able to do the following EXCEPT _____________.
　　[A] enjoy more rights to their medical records
　　[B] be open with their doctors
　　[C] decide how to use their medical information
　　[D] sue their insurers for improper use of their medical records
　　
　　3. Doctors tend to think that the rules _____________.
　　[A] may ruin doctor-patient relationship
　　[B] can do more harm than good
　　[C] will prevent doctors from doing medical research
　　[D] will end up in more health care cost and poorer medical service
　　
　　4. The example of the January poll by Princeton Survey Research Associates is used to show that __________________.
　　[A] American patients’ concealment of their medical information has become a big concern
　　[B] a large portion of patients would rather leave their diseases untreated
　　[C] concealing medical information is widespread in the U.S.
　　[D] paying cash for medical service is a common practice among American patients
　　
　　5. From the article we can learn that ________________.
　　[A] American government will tighten its control over the use of patients’ personal information.
　　[B] doctors and insurers are both against the rules for the same reasons
　　[C] patients are entitled to have complete control of their medical information
　　[D] the new rules put insurers in a very disadvantageous position
　　
　　答案：ABBAD
　　
　　篇章剖析
　　本文主要讲述了病人医疗隐私权立法及其引发的争议，采用的是指出问题——分析问题的模式。作者首先说明了病人医疗隐私泄露可能带来的问题，接着谈了提议中的病人医疗隐私权法案的内容。在第三段作者说明了反对该法案一方的观点。最后一段则强调了新法规的宗旨和不立法可能造成的不良后果。
　　　　　　
　　题目分析　　
　　1. 答案为A，属推理判断题。文章以医生利用先进的互联网技术传播病人医疗信息会有助于治疗某些病人的疾病，但同时又给一些病人在就业和购买保险方面带来困难为例说明保护病人医疗信息的重要性，以及不当使用技术可能带来的不良后果。　　
　　2. 答案为B，属事实细节题。"be open with their doctors ”只是这项法规试图达到的效果，并不是该法规赋予病人的权利。因此答案应该是B。　　
　　3. 答案为B，属事实细节题。文章引用医生的观点认为新法规不但不利于保护病人的隐私，反而会actually erode privacy，由此可见答案应该是B。　　
　　4. 答案为A，属推理判断题。前文讲到了病人因为羞于启齿或者担心失去保险赔付而隐瞒病情，使疾病得不到治疗;然后说The fear is real。继而引用普利斯顿调查研究协会的调查结果，意在说明这一问题的严重性。　　
　　5. 答案为D，属事实细节题。文章中提到保险公司的反对意见时，引用了保险公司的说法：the rules would make them vulnerable to lawsuits.由此可见答案应该是D。A项中提出的政府加强对病人私人信息的控制的说法是不正确的，因为保险公司抗议的是政府要加强对法规实施情况的审查(the increased level of federal scrutiny required by the new rules' enforcement provisions)。
　　
　　参考译文:　　　　　　

在医疗保健机构和在线医疗时代，即将发起的一场保护病人病历的战争背后的故事

　　技术是一把双刃剑。这一点在医疗保健领域尤为明显。借助技术，医生可以测试病人的遗传缺陷——并通过互联网很快将结果传遍全世界。对于那些需要治疗的人来说，这是好消息;但对于那些正在找工作，或者想要买一份保险的人来说，这样的消息可能非常糟糕。　
　　上周比尔•克林顿总统向国会提交了一份病人权利法案的推论：医疗隐私权。从2002年开始，根据2月即将生效的法规，病人将有权规定透露其个人医疗资料的条件。他们可以检查自己的病历并进行更正。他们也可以了解哪些人曾看过他们的信息。医护人员或者保险公司对病历使用不当将会导致民事或者刑事处罚。克林顿说，这一提案“在促使美国人重新获得对自己的病历控制权方面迈出了极其重要的一步。”　　
　　虽然政府称这些法规旨在平衡消费者和医疗保健行业的需求，但医生和保险公司对此都颇有微词。医生认为这些法规实际上是在破坏隐私权，因为其中一条规定允许管理式医疗保健计划(managed-care plan)在“开展医疗保健工作”时可以不经许可使用个人信息。医生们称其为一个漏洞，它使得医疗保健机构(HMO)和其他保险公司可以打着评估医疗保健质量的旗号窥探医患关系。同时，保险公司也对这些法规持反对意见，他们认为这些法规很容易让他们惹上官司。其中一条法规令他们尤为不满，该法规规定：保险公司对律师和会计这样的“商业伙伴”的侵犯隐私行为负责。这两个群体都一致认为，保护隐私会使医疗保健成本增加至少38亿美元，在接下来的五年里也许还会增加更多。根据新法规的执行条例，联邦政府将加大对医疗保健行业的审查力度，他们对此也表示不满。　　
　　新法规的目标之一就是要让病人不再担心自己的隐私被泄漏，从而鼓励他们对医生坦诚相告。今天各种各样的癌症和性病可能会因为病人羞于启齿或者担心失去保险赔付而得不到治疗。这种担心并非无中生有：克林顿的助手补充说，由普林斯顿调查研究协会在一月份进行的一项民意测试显示，在美国，每六个成年人中就有一个曾经做过刻意隐瞒医疗信息的事情，比如用现金支付服务费。