In the health-care industry, the doctor-patient relationship is the mirror image of the ordinaryrelationship between producer and consumer. Once an individual has chosen to see aphysician-and even then there may be no real choice-it is the physician who usually makes allsignificant purchasing decisions: whether the patient should return "next Wednesday", whetherX-rays are needed, whether drugs should be prescribed, etc. It is a rare and sophisticatedpatient who will challenge such professional decisions or raise in advance questions aboutprice, especially when the disease is regarded as serious.

　　This is particularly significant in relation to hospital care. The physician must certify the needfor hospitalization, determine what procedures will be performed, and announce when thepatient may be discharged. The patient may be consulted about some of these decisions, but inthe main it is the doctor's judgments that are final. Little wonder then that in the eye of thehospital it is the physician who is the real "consumer." As a consequence, the medical staffrepresents the "power center" in hospital policy and decision-making, not the administration.

　　Although usually there are in this situation four identifiable participants-the physician, thehospital, the patient, and the payer (generally an insurance carrier or government)-thephysician makes the essential decisions for all of them. The hospital becomes an extension ofthe 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 percentof health-care expenditures are determined by physicians, not patients. For this reason, theeconomy directed at patients or t.he general is relatively ineffective.

　　衛(wèi)生保健行業(yè)存在著許多不同尋常的、甚至是獨(dú)一無二的經(jīng)濟(jì)關(guān)系。其中人們了解最少的包括在典型的醫(yī)患關(guān)系中生產(chǎn)者或“供應(yīng)者”與購買者或“消費(fèi)者”之聞的奇特的角色關(guān)系。在大部分經(jīng)濟(jì)領(lǐng)域，是銷售者努力用價格、質(zhì)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(wèi)生保健行業(yè)，多數(shù)情況下并不是這樣的。

　　[2]衛(wèi)生保健行業(yè)中的醫(yī)患關(guān)系與一般的生產(chǎn)者-消費(fèi)者之間的關(guān)系剛好相反。一旦某人選擇了請某個醫(yī)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(yī)生做出所有重要的購買決定：病人是否應(yīng)該“下個星期三”來復(fù)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(zhì)疑這些專業(yè)人員的決定，或者提前詢問價錢，尤其是當(dāng)其病情非常嚴(yán)重的時候。

　　當(dāng)需要住院治療時，這種關(guān)系尤為明顯。醫(yī)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(yī)生的決定才具有決定性。[4]難怪在醫(yī)院看來，醫(yī)生才是真正的“消費(fèi)者”。這樣做的結(jié)果是，代表醫(yī)院“權(quán)力中心”來制定政策及決策的是醫(yī)護(hù)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(yī)生、醫(yī)院、病人及付款者(一般為保險公司或政府)一一但是醫(yī)生替各方做最重要的決定。醫(yī)院成了醫(yī)生的延伸：付款者通常支付醫(yī)生/醫(yī)院開出的大部分費(fèi)用，而在很大程度上病人都是一個被動的角色。[5]據(jù)估計(jì)，衛(wèi)生保健費(fèi)用的75-80%是由醫(yī)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(jīng)濟(jì)體制相對而言是無效的。

　　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

　　1.作者寫這篇文章的主要目的是什么?

　　A)譴責(zé)醫(yī)生對病人的控制太多。

　　B)分析衛(wèi)生保健中的幾個重要經(jīng)濟(jì)因素。

　　C)催促醫(yī)院收回他們的決策權(quán)。

　　D)讓潛在病人知道他們的衛(wèi)生保健權(quán)利。

　　[B]文章首段表明本文將要討論衛(wèi)生保健行業(yè)中醫(yī)生和病人的特殊經(jīng)濟(jì)關(guān)系，其余三段分析了這種經(jīng)濟(jì)關(guān)系的特別之處，由此可見，選項(xiàng)B可以概括本文主題，故為本題答案。

　　2.在衛(wèi)生保健行業(yè)，病人__________。

　　A)擔(dān)當(dāng)“供應(yīng)者”的角色

　　B)決定向哪一位醫(yī)生咨詢

　　C)從不問關(guān)于價錢的問題

　　D)從不向醫(yī)生咨詢

　　[A]第2段首句中的mirror image表明醫(yī)患關(guān)系與傳統(tǒng)的生產(chǎn)者一消費(fèi)者的關(guān)系相反，即醫(yī)生充當(dāng)消費(fèi)者的角色，而患者充當(dāng)生產(chǎn)者的角色，結(jié)合首段第2句中指出的生產(chǎn)者即供應(yīng)者，可以推斷選項(xiàng)A為本題答案。

　　3.根據(jù)作者所述，當(dāng)一位醫(yī)生告訴病人“下周三再來”時，醫(yī)生實(shí)際上是_________。

　　A)指示病人購買更多醫(yī)療服務(wù)

　　B)告誡病人需要住院治療

　　C)建議病人尋求另一種觀點(diǎn)

　　D)承認(rèn)(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(yī)生做出所有重要的購買決定”。選項(xiàng)中只有A與“購買”有關(guān)，故為本題答案。

　　4.醫(yī)生能夠決定醫(yī)院方案，最可能是因?yàn)開__________。

　　A)醫(yī)院的財(cái)政收入靠醫(yī)生

　　B)病人的健康最終由醫(yī)生決定

　　C)大多數(shù)病人不會挑戰(zhàn)醫(yī)生的決定

　　D)行政部門對醫(yī)藥的了解比醫(yī)生少

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

　　5.作者在下文最可能是會_______________。

　　A)分析醫(yī)院行政擔(dān)當(dāng)?shù)慕巧?/p>

　　B)研究關(guān)于醫(yī)生失職的訴訟

　　C)討論一種新的醫(yī)療

　　D)提議對醫(yī)療費(fèi)用進(jìn)行管控

　　[D]原文主要分析了醫(yī)生和病人之間特殊的經(jīng)濟(jì)關(guān)系，末段最后兩句指出大部分衛(wèi)生保健費(fèi)用由醫(yī)生決定，正因?yàn)槿绱耍@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(jìn)行改革，選項(xiàng)D與此最為接近。