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 the 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, economy directed at patients or the general are relatively ineffective.
1.The author's primary purpose is to（ ）.
2.It can inferred that doctors are able to determine hospital policies because （ ）.
3.According to the author, when a doctor tells a patient to "return next Wednesday", the doctor is in effect （ ）.
4.The author is most probably leading up to （ ）.
5.With which of the following statements would the author be likely to agree?
问题1选项
A.criticize doctors for exercising too much control over patients
B.analyze some important economic factors in health-care
C.urge hospitals to reclaim their decision-making authority
D.inform potential patients of their health-care rights
问题2选项
A.it is doctors who generate income for the hospital
B.most of patient's bills are paid by his health insurance
C.a doctor is ultimately responsible for a patient's health
D.some patients might refuse to accept their physician's advice
问题3选项
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
问题4选项
A.a proposal of control medical costs
B.a discussion of a new medical treatment
C.an analysis of the cause of inflation in the United States
D.a study of lawsuits against doctors for malpractice
问题5选项
A.Few patients are reluctant to object to the course of the treatment prescribed by a doctor or to question the cost of the services.
B.The more serious the illness of a patient, the less likely it is that the patient will object to the course of treatment prescribed or to question the cost of services.
C.The payer, whether insurance carrier or the government, is less likely to acquiesce to demands for payment when the illness of the patient is regarded as serious.
D.Both A and B.
第1题:B
第2题:A
第3题:A
第4题:A
第5题:B
第1题:
1.主旨大意题。文章第一段提到在经济的大部分领域购买者做出决定，但在医学领域却不是如此（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.）文章主要讲述了卫生保健领域医生和病人奇怪的经济关系，其他几段分析了这种关系的不同之处，因此选项B符合题意。
第2题:
2.推理判断题。文章第三段最后一句话提到“因此，在医院的政策和决策中，医务人员是‘权力中心’，而不是行政部门”（As a consequence, the medical staff represents the "power center" in hospital policy and decision-making, not the administration），根据as a consequence可知，原因在该句的前面，Little wonder then that in the eye of the hospital it is the physician who is the real "consumer."（难怪在医院的眼里医生才是真正的消费者）。也就是说医生决定了医院的收入，选项A符合题意。
第3题:
3.推理判断题。文章第二段提到“医生通常做出所有重大的购买决定，如：病人是否应该在下周三回医院”（it is the physician who usually makes all significant purchasing decisions: whether the patient should return "next Wednesday"），选项A“指导病人买更多的医疗服务”符合题意。
第4题:
4.推理判断题。最后一段作者指出75%-80%的医疗花费是由医生决定的，而不是病人（We estimate that about 75-80 percent of health-care expenditures are determined by physicians, not patients），因此针对病人或一般人的节约是相对无效的（For this reason, economy directed at patients or the general are relatively ineffective），由此可以看出作者对这种做法是持否定意见的，所以作者接下来可能会提出一些建议来改变这种行为，选项A“控制医疗成本的建议”符合题意。
第5题:
5.观点态度题。文章第二段最后一句提到很少有病人会为价格问题来质疑医生，尤其是那些病重的病人（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），选项B符合题意。
