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(cè)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(xiě)這篇文章的主要目的是什么?

　　A)譴責(zé)醫(yī)生對(duì)病人的控制太多。

　　B)分析衛(wèi)生保健中的幾個(gè)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(jiàn)，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(wèn)關(guān)于價(jià)錢(qián)的問(wèn)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(lái)”時(shí)，醫(yī)生實(shí)際上是_________。

　　A)指示病人購(gòu)買(mǎi)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(wú)效

　　[A]在第2段第2句中，三個(gè)whether引出的例子是為了說(shuō)明冒號(hào)前的“通常是由醫(yī)生做出所有重要的購(gòu)買(mǎi)決定”。選項(xiàng)中只有A與“購(gòu)買(mǎi)”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(kāi)__________。

　　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(huì)挑戰(zhàn)醫(yī)生的決定 D)行政部門(mén)對(duì)醫(yī)藥的了解比醫(yī)生少

　　[A]第3段末句開(kāi)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(lái)收入的人，由此可見(jiàn)，選項(xiàng)A為本題答案。

　　5.作者在下文最可能是會(huì)_______________。

　　A)分析醫(yī)院行政擔(dān)當(dāng)?shù)慕巧?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(duì)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?，這樣的體制顯得ineffective。由此可以推斷，作者接下來(lái)會(huì)提出對(duì)這種體制進(jìn)行改革，選項(xiàng)D與此最為接近。

　　參考譯文

　　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(wú)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(gòu)買(mǎi)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(xiāo)售者努力用價(jià)格、質(zhì)量、用途等各種誘惑來(lái)吸引潛在的購(gòu)買(mǎi)者，而做決定的是購(gòu)買(mǎi)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(qǐng)某個(gè)醫(yī)生看病一一即使在那時(shí)可能并沒(méi)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(gòu)買(mǎi)決定：病人是否應(yīng)該“下個(gè)星期三”來(lái)復(fù)診，是否需要拍X光片，是否需要開(kāi)些藥，等等。很少有精明的病人會(huì)質(zhì)疑這些專業(yè)人員的決定，或者提前詢問(wèn)價(jià)錢(qián)，尤其是當(dāng)其病情非常嚴(yán)重的時(shí)候。

　　當(dāng)需要住院治療時(shí)，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(guò)程，宣布病人何時(shí)可以出院。其中某些決定可能會(huì)征求病人的意見(jiàn)，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(lái)，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(lái)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(shí)別的參與者一一醫(yī)生、醫(yī)院、病人及付款者(一般為保險(xiǎn)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(kāi)出的大部分費(fèi)用，而在很大程度上病人都是一個(gè)被動(dòng)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(duì)病人或普通老百姓的經(jīng)濟(jì)體制相對(duì)而言是無(wú)效的。