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  3. The health-care economy is filled with unusual and even unique economic relationships. One of the least understood involves the

The health-care economy is filled with unusual and even unique economic relationships. One of the least understood involves the

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问题     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, the economy directed at patients or the general is relatively ineffective.
The author is most probably leading up to ________.
选项 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D
解析 根据题干提示定位到末段。原文主要分析了医生和病人之间特殊的经济关系，来段最后两句指出大部分卫生保健费用由医生决定，正因为如此，这样的体制ineffective，由此可以推断，作者接下来会提出对这种体制进行改革，选项D与此最为接近。本文主要讨论的是医生和病人在经济中的角色，作者接下来要讨论的应该仍然是经济方面的问题。选项A关注的是“医院管理”，选项B关注的是“医生的失职”，选项C关注的是“医疗方法”，这些都与“经济”没有明显的关系；另外，选项B和C提到的问题在本文并未提及，而选项A只在第3段末稍有提及，但那是为了说明本文主题而提到的细节，不是作者关注的主要问题。
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