Directions:

　　In the following text, some sentences have been removed. For Questions 41-45, choose the most suitable one from the list A-G to fit into each of the numbered blanks. There are two extra choices, which do not fit in any of the blanks. Mark your answers on ANSWER SHEET 1. (10 points)

　　Canada’s premiers (the leaders of provincial governments), if they have any breath left after complaining about Ottawa at their late July annual meeting, might spare a moment to do something, together, to reduce health-care costs.

　　They’re all groaning about soaring health budgets, the fastest-growing component of which are pharmaceutical costs.

　　41.

　　What to do? Both the Romanow commission and the Kirby committee on health care—to say nothing of reports from other experts—recommended the creation of a national drug agency. Instead of each province having its own list of approved drugs, bureaucracy, procedures and limited bargaining power, all would pool resources, work with Ottawa, and create a national institution.

　　42.

　　But “national” doesn’t have to mean that. “National” could mean interprovincial—provinces combining efforts to create one body. Either way, one benefit of a “national” organization would be to negotiate better prices, if possible, with drug manufacturers. Instead of having one province—or a series of hospitals within a province—negotiate a price for a given drug on the provincial list, the national agency would negotiate on behalf of all provinces. Rather than, say, Quebec, negotiating on behalf of seven million people, the national agency would negotiate on behalf of 31 million people. Basic economics suggests the greater the potential consumers, the higher the likelihood of a better price.

　　43.

　　A small step has been taken in the direction of a national agency with the creation of the Canadian Co-ordinating Office for Health Technology Assessment, funded by Ottawa and the provinces. Under it, a Common Drug Review recommends to provincial lists which new drugs should be included. Predictably, and regrettably, Quebec refused to join.

　　A few premiers are suspicious of any federal-provincial deal-making. They (particularly Quebec and Alberta) just want Ottawa to fork over additional billions with few, if any, strings attached. That’s one reason why the idea of a national list hasn’t gone anywhere, while drug costs keep rising fast.

　　44.

　　Premiers love to quote Mr. Romanow’s report selectively, especially the parts about more federal money. Perhaps they should read what he had to say about drugs.

　　“A national drug agency would provide governments more influence on pharmaceutical companies in order to try to constrain the ever-increasing cost of drugs.”

　　45.

　　So when the premiers gather in Niagara Falls to assemble their usual complaint list, they should also get cracking about something in their jurisdiction that would help their budgets and patients.

　　［A］ Quebec’s resistance to a national agency is provincialist ideology. One of the first advocates for a national list was a researcher at Laval University. Quebec’s Drug Insurance Fund has seen its costs skyrocket with annual increases from 14.3 per cent to 26.8 per cent!

　　［B］ Or they could read Mr. Kirby’s report: “The substantial buying power of such an agency would strengthen the public prescription-drug insurance plans to negotiate the lowest possible purchase prices from drug companies.”

　　［C］ What does “national” mean? Roy Romanow and Senator Michael Kirby recommended a federal-provincial body much like the recently created National Health Council.

　　［D］ The problem is simple and stark: health-care costs have been, are, and will continue to increase faster than government revenues.

　　［E］ According to the Canadian Institute for Health Information, prescription drug costs have risen since 1997 at twice the rate of overall health-care spending. Part of the increase comes from drugs being used to replace other kinds of treatments. Part of it arises from new drugs costing more than older kinds. Part of it is higher prices.

　　［F］ So, if the provinces want to run the health-care show, they should prove they can run it, starting with an interprovincial health list that would end duplication, save administrative costs, prevent one province from being played off against another, and bargain for better drug prices.

　　［G］ Of course, the pharmaceutical companies will scream. They like divided buyers, they can lobby better that way. They can use the threat of removing jobs from one province to another. They can hope that, if one province includes a drug on its list, the pressure will cause others to include it on theirs. They wouldn’t like a national agency, but self-interest would lead them to deal with it.

　　答案与解析

　　41.【答案】E

　　【解析】

　　本题上面一段讲的中心是药品价钱，经过分析这七个选项发觉，选项E在归纳句子，和上面的也有连贯性，哪一个选项当中包含了

　　42.【答案】C

　　【解析】 如果只要上下一加就很明显发现，句中出现最多的就是国家这个词，空后文字非常典型，提到But “national” doesn’t have to mean that。很明显这是一个转折，表明空处所填的选项，要和这一句话形成转折关系，而且空里面要出现“national”的定义，就是说很有可能要出现“national”这个词儿。哪一个选项里面包含这个词呢？C选项提到national为正确答案。

　　43.【答案】G

　　【解析】 在上一段所讲的是国家要对药品进行一种控制，空前文字举例说明全国性代理机构的好处，举了魁北克的例子，选项应该围绕着这个问题来选，正确答案选G，很好的保持了文章的一致性，G选项说“当然药厂不会同意，他们喜欢散客买家，那样他们可以暗中运作，他们甚至可能会威胁着要把一个省的工作机会转移到另一个省，但是，处于利益的驱使，他们又不得不这样做。

　　44.【答案】F

　　【解析】 有两个选择可以选进去的，我们可以根据这篇文章总体的情感来判断，前面一段直接讲的就是，人们对于整体药品的价格，以及国家的机构都是抱怨的态度，空前有两段文字，第一段最后提到魁北克拒绝加入全国性代理机构。而第二段提到有很多省府官员对于这种全国性代理机构持怀疑态度，可以发现这里仍然推行全国性代理机构的设想所遇到的阻力，接下来当然会谈到怎么处理这个阻力？F选项，非常明确的说明了“所以如果某些省想完成健康福利的任务，他们就必须有完成这个任务的能力，他们还必须节约管理成本，防止一个省和另一个省之间的斗争，而且还要尽量争取更好的药价。”所以选项A和F相比，F要更符合这篇文章情感的一致性，所以选F，这个空很多同学填的都是A，A选项说：“魁北克抵制全国性代理机构，是这个省自己的意识形态问题”。

　　45.【答案】B

　　【解析】 上面出现了一个“人们怎么样说”最后一段也讲了，他们聚在首都，不断谈论这个事情，这个一致性，本题应该选B。空前文字提到也许这些官员们应该看一看

　　全文精译

　　在七月底的年度会议上对渥太华大发牢骚之后，加拿大的省府官员们如果还有力气的话，他们可能会抽出时间坐到一块儿，力图降低医疗费用。

　　他们所有人都在抱怨高涨的医疗预算，这其中增长最快的是药品费用。

　　41)加拿大医疗信息协会的资料表明，自1997年以来，处方药费用的增长速度是整个医疗费用增长速度的两倍。其中部分增长是由于药物使用替代了其他的治疗手段。部分是由于使用了高于原来药品价格的新药，部分是由于药品价格涨了。

　　该怎么办呢？许多专家提出了报告，这自不必说。罗马诺医疗委员会和科尔比医疗委员会则建议设立一个国家药物机构。由现在每个省出台自己的药物清单，有自己的机构、程序和有限的议价能力这种情况，变更为资源共享，一同与渥太华合作创建一个国家机构。

　　42)这里所说的国家机构是指什么呢？罗伊•罗马诺和迈克尔•科尔比议员建议成立一个联邦政府和省政府一体化的机构，就像最近成立的国家医疗委员会一样。

　　但是国家机构的含义不一定是指这一点。它还可意味着各省之间联合起来创建一个机构。不管是何种含义，如果可能的话，成立一个国家机构的好处之一就是能够通过谈判从医药生产商那里获得更优惠的价格。原来是一个省或省内的几家

　　43)当然，医药公司就会高声欢呼了。他们喜欢散客买家，那样他们可以更好地为自己的利益而进行游说。他们可能会以要把一个省的工作机会转移到另一个省来进行威胁。他们可能会认为如果一个省的药单上包括了一种药，就会迫使其他的省把这种药也填在药单上，他们不会喜欢全国性代理机构。但是，由于利益的驱使，他们又不得不与它打交道。

　　由渥太华和各省出资成立了加拿大医疗技术评估协调办公室，这意味着向成立国家机构迈进了一小步。在这个办公室下有一个公共药品评估机构，它向各省推荐应该在清单上增加的新药。不出所料，魁北克省拒绝加入这个机构，这是个遗憾。

　　一些省府官员们对于联邦政府和省之间的交易感到怀疑。他们(尤其是魁北克省和阿尔伯特省)只想让渥太华额外支付上几十亿加元，但自己却不承担任何责任(如果他们有责任的话)。这就是为什么提出一个国家药物清单的想法得不到落实，而药品价格却不断上涨。

　　44)所以如果某些省想操控医疗福利事业，他们就必须证明自己有这种能力，他们必须开一张省际单子来终止重复，他们还必须节约管理成本，防止各省之间的争斗，而且还要尽量争取更合理的药价。

　　官员们喜欢有选择地引用罗马诺先生的报告，特别是有关联邦资金的部分。也许他们应该读读他们不得不说的有关药物的部分了：“为了抑制不断上涨的药价，一个国家药物机构会让政府对医药公司施加更大的影响。”

　　45)或者他们可以看一看科尔比的报告：“这样一个机构的巨大购买力，会进一步加强实施公众处方药保险计划，以保证以可能的最低价格从药厂买药。”

　　因此当官员们聚集在尼亚加拉瀑布城开会陈述他们的抱怨清单时，他们应该在自己的权限范围内开始做些有利于他们的预算及病人的事情。

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