Public general hospitals originated VER 2.0 FULL PASSAGE

Public general hospitals originated in the almshouse infirmaries established as early as colonial times by local governments to care for the poor. Later, in the late eighteenth and early nineteenth centuries, the infirmary 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 provided mainly food and shelter for the impoverished sick, since 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, the private charity hospital 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 which forced them to look to local government for financial 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 non-paying patients and made 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 and the public hospitals remained dependent on the tax dollars.

The advent of private hospital health insurance, which provided middle-class patients with the purchasing power to pay for private hospital services, guaranteed the private hospital a regular source of income. Private hospitals restricted themselves to revenue-generating patients, leaving the public hospitals to care for the poor. Although public hospitals continued to provide services for patients with communicable diseases and outpatient and emergency services, the Blue Cross plans developed around the needs of the private hospitals and the inpatients they served. Thus, reimbursement for ambulatory care has been minimal under most Blue Cross plans, and 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. Additionally, since World War II, there has been a tremendous influx of federal money into private medical schools and the hospitals associated with them. Further, large private medical centers with expensive research equipment and programs have attracted the best administrators, physicians, and researchers. As a result of the greater resources available to the private medical centers, public hospitals have increasing problems attracting highly qualified research and medical personnel. With the mainstream of health care firmly established in the private medical sector, the public hospital has become a “dumping ground.”

1. The primary purpose of the passage is to
(A) discuss the economic basis of the medieval practice of exchanging prisoners for ransom
(B) examine the history of the treatment of prisoners of war
(C) emphasize the importance of a warrior’s “word of honor” during the Middle Ages
(D) explore three ways of reducing the costs of ransom
(E) demonstrate why warriors of the Middle Ages looked forward to battles
2. It can be inferred from the passage that a medieval soldier
(A) was less likely to kill captured members of opposing armies than was a soldier of the Roman Empire
(B) was similar to a 20th-century terrorist in that he operated on a basically independent level and was motivated solely by economic incentives
(C) had few economic options and chose to fight because it was the only way to earn an adequate living
(D) was motivated to spare prisoners’ lives by humanitarian rather than economic ideals
(E) had no respect for his captured enemies since captives were typically regarded as weak
3. Which of the following best describes the change in policy from executing
prisoners in Roman times to ransoming prisoners in the Middle Ages?
(A) The emperors of Rome demanded more respect than did medieval rulers and thus Roman subjects went to greater lengths to defend their nation.
(B) It was a reflection of the lesser degree of direct control medieval rulers had over their subjects.
(C) It became a show of strength and honor for warriors of the Middle Ages to be able to capture and return their enemies.
(D) Medieval soldiers were not as humanitarian as their ransoming practices might have indicated.
(E) Medieval soldiers demonstrated more concern about economic policy than did their Roman counterparts.
4. The author uses the phrase “without much distortion” (line 26) in order
(A) to indicate that prisoners would fairly assess their worth
(B) to emphasize the important role medieval prisoners played in determining whether they should be ransomed
(C) to explain how prisoners often paid more than an appropriate ransom in order to increase their chances for survival
(D) suggest that captors and captives often had understanding relationships
(E) to show that when in prison a soldier’s view could become distorted
5. All of the following are mentioned in the passage as actions that were taken to ensure that ransoming prisoners was a profitable operation EXCEPT
(A) each prisoner was made to designate the amount of ransom to be paid for his return
(B) prisoners were released on the condition that they guaranteed that their
ransoms would be paid
(C) professional intermediaries were employed to facilitate the smooth exchange of prisoner and ransom at a price to the prisoner
(D) religious orders acted as impartial mediators by arranging the trade-off of ransom and prisoner
(E) medieval rulers promised to aid soldiers in their efforts to collect ransom
6. In the author’s opinion, a soldier’s decision to spare an adversary’s life be linked historically to
(A) the economic relationship of the warring states
(B) the case with which a soldier could capture and subsequently imprison his enemy
(C) the economic gain from taking an enemy prisoner rather than killing him in combat
(D) technological advances in weaponry
(E) the desire for soldiers to uphold their word of honor
7. It can be inferred from the passage that the process of arranging ransoms during medieval times was
(A) more lucrative for medieval soldiers and kings than the winning of spoils
(B) a procedure so costly that it was not economically worthwhile for the captors
(C) futile for the captive since he risked recapture even after his ransom was paid
(D) a potential source of income for others aside from the captors of the prisoners
(E) handled only through Mercedarian or Trinitarian intermediaries
8. Which of the following best describes the organization of the passage?
A. An assertion is made, briefly explained, and then several examples that refute the assertion are given.
B. A hypothesis is offered, carefully qualified, and then supporting data is analyzed.
C. A generally accepted historical viewpoint is presented in order to introduce discussion of its strengths and limitations.
D. A historical analysis is made of a phenomenon and supporting details are offered.
E. A historical dispute is introduced, and the case for one side is examined in detail.