The health-care economy is filled with unusual and even unique economic relationships. One of the least understood involves the peculiar roles of producer or "provider" and purchaser or "consumer" in the typical doctor-patient relationship. In most sectors of the economy, it is the seller who attempts to attract a potential buyer with various inducements of price, quality, and utility, and it is the buyer who makes the decision, Such condition, however, does not prevail in most of the health-care industry.

　　In the health-care industry, the doctor-patient relationship is the mirror image of the ordinary relationship between producer and consumer. Once an individual has chosen to see a physician-and even then there may be no real choice-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 and sophisticated patient who will challenge such professional decisions or raise in advance questions about price, especially when the disease is regarded as serious.

　　This is particularly significant in relation to hospital care. The physician must certify the need for hospitalization, determine what procedures will be performed, 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. Little wonder then 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 identifiable participants-the physician, the hospital, the patient, and the payer (generally an insurance carrier or government)-the physician makes the essential decisions for all of them. The hospital becomes an extension of the physician; the payer generally meets most of the bills generated by the physician/hospital, and for t/he most part the patient plays a passive role. We estimate that about 75-80 percent of health-care expenditures are determined by physicians, not patients. For this reason, the economy directed at patients or t.he general is relatively ineffective.

　　測試題

　　1.What's the author's main purpose in writing this passage?

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

　　B) To analyze some important economic factors in health-care.

　　C) To urge hospitals to reclaim their decision making authority.

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

　　2.In the health-care industry, the patients

　　A) perform the role of being "providers”

　　B) decide which physician to consult

　　C) never raise questions about price

　　D) never consult with the doctors

　　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) warning the patient that a hospital stay might be necessary

　　C) advising the patient to seek a second opinion

　　D) admitting that the initial visit, was ineffective

　　4.Doctors are able to determine hospital policies most probably because_______.

　　A) it is doctors who generate income for the hospital

　　B) a doctor is ultimately responsible for a patient's health

　　C) most of the patients don't challenge the doctor's decisions

　　D) the administration doesn't know about medicine as much as doctors

　　5.The author is most probably leading up to_________.

　　A) an analysis of the role of the hospital administration

　　B) a study of lawsuits against doctors' malpractice

　　C) a discussion of a new medical treatment

　　D) a proposal to control medical costs

　　答案詳解

　　1.作者寫這篇文章的主要目的是什么?

　　A)譴責醫生對病人的控制太多。

　　B)分析衛生保健中的幾個重要經濟因素。

　　C)催促醫院收回他們的決策權。

　　D)讓潛在病人知道他們的衛生保健權利。

　　[B]文章首段表明本文將要討論衛生保健行業中醫生和病人的特殊經濟關系，其余三段分析了這種經濟關系的特別之處，由此可見，選項B可以概括本文主題，故為本題答案。

　　2.在衛生保健行業，病人__________。

　　A)擔當“供應者”的角色

　　B)決定向哪一位醫生咨詢

　　C)從不問關于價錢的問題

　　D)從不向醫生咨詢

　　[A]第2段首句中的mirror image表明醫患關系與傳統的生產者一消費者的關系相反，即醫生充當消費者的角色，而患者充當生產者的角色，結合首段第2句中指出的生產者即供應者，可以推斷選項A為本題答案。

　　3.根據作者所述，當一位醫生告訴病人“下周三再來”時，醫生實際上是_________。

　　A)指示病人購買更多醫療服務 B)告誡病人需要住院治療

　　C)建議病人尋求另一種觀點 D)承認(病人)第一次到訪無效

　　[A]在第2段第2句中，三個whether引出的例子是為了說明冒號前的“通常是由醫生做出所有重要的購買決定”。選項中只有A與“購買”有關，故為本題答案。

　　4.醫生能夠決定醫院方案，最可能是因為___________。

　　A)醫院的財政收入靠醫生 B)病人的健康最終由醫生決定

　　C)大多數病人不會挑戰醫生的決定 D)行政部門對醫藥的了解比醫生少

　　[A]第3段末句開頭的As a consequence表明醫護人員能夠決定醫院政策的原因在前一句有提到，前一句指出醫生才是真正的“消費者”，即醫生才是給醫院帶來收入的人，由此可見，選項A為本題答案。

　　5.作者在下文最可能是會_______________。

　　A)分析醫院行政擔當的角色 B)研究關于醫生失職的訴訟

　　C)討論一種新的醫療 D)提議對醫療費用進行管控

　　[D]原文主要分析了醫生和病人之間特殊的經濟關系，末段最后兩句指出大部分衛生保健費用由醫生決定，正因為如此，這樣的體制顯得ineffective。由此可以推斷，作者接下來會提出對這種體制進行改革，選項D與此最為接近。

　　參考譯文

　　衛生保健行業存在著許多不同尋常的、甚至是獨一無二的經濟關系。其中人們了解最少的包括在典型的醫患關系中生產者或“供應者”與購買者或“消費者”之聞的奇特的角色關系。在大部分經濟領域，是銷售者努力用價格、質量、用途等各種誘惑來吸引潛在的購買者，而做決定的是購買者。然而，在衛生保健行業，多數情況下并不是這樣的。

　　[2]衛生保健行業中的醫患關系與一般的生產者-消費者之間的關系剛好相反。一旦某人選擇了請某個醫生看病一一即使在那時可能并沒有真正的選擇余地一一[3]通常是由醫生做出所有重要的購買決定：病人是否應該“下個星期三”來復診，是否需要拍X光片，是否需要開些藥，等等。很少有精明的病人會質疑這些專業人員的決定，或者提前詢問價錢，尤其是當其病情非常嚴重的時候。

　　當需要住院治療時，這種關系尤為明顯。醫生必須證明住院的必要性，決定需要哪些治療過程，宣布病人何時可以出院。其中某些決定可能會征求病人的意見，但一般情況下，醫生的決定才具有決定性。[4]難怪在醫院看來，醫生才是真正的“消費者”。這樣做的結果是，代表醫院“權力中心”來制定政策及決策的是醫護人員，而不是行政人員。

　　雖然在這種情況下通常有四方可識別的參與者一一醫生、醫院、病人及付款者(一般為保險公司或政府)一一但是醫生替各方做最重要的決定。醫院成了醫生的延伸：付款者通常支付醫生/醫院開出的大部分費用，而在很大程度上病人都是一個被動的角色。[5]據估計，衛生保健費用的75-80%是由醫生而不是病人決定的。因此，這種針對病人或普通老百姓的經濟體制相對而言是無效的。