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

The health-care economy is replete 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 replete 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 theseller who attempts to attract a potential buyer with various inducements of price，quality，andutility，and it is the buyer who makes the decision．Where circumstances permit the buyer nochoice because there is effectively only one seller and the product is relatively essential，government usually asserts monopoly and places the industry under price and other regulations．
Neither of these conditions prevails in most of the health-care industry．
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 a physician andeven then there may be no real choice--it is the physician who usually makes all significantpurchasing decisions：whether the patient should return“next Wednesday”．whether X-rays areneeded，whether drugs should be prescribed，et@C@It is a rare and sophisticated patient who willchallenge such professional decisions or raise in advance questions about price，especially when theailment 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 the patientmay be discharge@D@The patient may be consulted about some of these decisions，but in the main itis the doctor’S judgments that are final．Little wonder then that in the systems of the hospital it isthe 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，thehospital，the patient，and the payer(generally an insurance carrier or government)—the physicianmakes the essential decisions for all of them．The hospital becomes an extension of the physician；the payer generally meets most of the real bills generated by the physician／hospital；and for themost part the patient plays a passive role．In routine or minor illnesses，or just plain worries，thepatient’s options are，of course，much greater with respect to use and price．In illnesses that are ofsome significance，however，such choices tend to evaporate，and it is for these illnesses that thebulk of the health-care dollar is spent．We estimate that about 75-80 percent of health-careexpenditures are determined by physicians，not patients．For this reason，economy measuresdirected at patients or the general public are relatively ineffective．
It can be inferred that doctors are able to determine hospital policies because______．
选项 A、it is doctors who generate income for the hospital
B、most of a patient’s bills are paid by his health insurance
C、hospital administrators lack the expertise to question medical
D、a doctor is ultimately responsible for a patient’s health
答案A
解析 细节推理题。文章最后一段提到，虽然在这种情况下通常有四个明晰可辨的参与者——医生、医院、病人和付款人(通常是保险公司或政府)，但是医生却为所有人做出重大决定。医院成为医生的延伸物，付款人通常支付医生所开具的大部分账单，病人在很大程度上只扮演一个被动角色。由此可以推出，医生之所以能起到决定性作用，是因为他们实际上在控制着医院的收入，所以选项A为正确答案。C项“医院的行政人员缺乏置疑医疗决定的专业知识”看上去合理，但与文章不符。
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