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4、The health – care economy is filled with unusual and even unique economic relationships. One of the least understood involves the special roles of producer or “provider” and purchaser or “consumer” in the typical doctor – patient relationship. In most areas of the economy, it is the seller who attempts to attract a potential buyer, and it is the buyer who makes the decision. Such condition, however, does not exist in most of the health – care industry.

In the health – care industry, the doctor – patient relationship is different from the ordinary relationship between producer and consumer. Once an individual has chosen to see a physician, it is the physician who usually makes all significant purchasing decisions: whether the patient should “return next Wednesday”, whether X-rays are needed, whether drugs should be prescribed, etc. It is a rare patient who will challenge such professional decisions, especially when the disease is regarded as serious.

This is particularly significant in relation to hospital care. The physician must provide evidence for the need for hospitalization, and announce when the patient may be discharged. The patient may be consulted about some of these decisions, but in the main it is the doctor’s judgments that are final. No wonder that in the eye of the hospital it is the physician who is the real “consumer”. As a consequence, the medical staff represents the “power center” in hospital policy and decision-making, not the administration.

Although usually there are in this situation four participants — the hospital, the physician, the patient, and the payer (generally an insurance carrier or government) — the physician makes the essential for all of them. We estimate that about 75 – 80 percent of health – care expenses are determined by physicians, not patients. For this reason, economy (節(jié)約) directed at patients or the general are ineffective.

1．The author’s primary purpose is to              .

       A．criticize doctors for exercising too much control over patients.

       B．a(chǎn)nalyze some important economic factors in health-care.

       C．urge hospitals to change their decision-making authority.

       D．inform potential patients of their health-care rights.

2．Doctors are able to determine hospital policies because         .

       A．it is doctors who bring in income for the hospital

       B．it is doctors who arm with professional skills

       C．a(chǎn) doctor is responsible for a patient’s health

       D．a(chǎn) doctor is in charge of a patient’s hospital care

3．According to the author, when a doctor tells a patient to “return next Wednesday”, the doctor is in effect             .

       A．instructing the patient to buy more medical services.

       B．reminding the patient of the exact time to come again.

       C．a(chǎn)dvising the patient to seek a second opinion.

       D．a(chǎn)dmitting that the initial visit was ineffective.

4．The author is most probably preparing for          .

       A．a(chǎn) proposal to control medical costs.

       B．a(chǎn) discussion of a new medical treatment.

       C．a(chǎn)n analysis of the cause of the doctor – patient conflicts.

       D．a(chǎn) study of cases against doctors for neglecting their duty.

5．The author is likely to agree that         .

       A．patients tend to object to the course of the treatment prescribed by a doctor

       B．a(chǎn) seriously – sick patient is less likely to object to the course of treatment prescribed

       C．the payer is less likely to pay when the patient’s illness is serious

       D．patients would dislike the physician’s decisions when the diseases are serious