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

The health-care economy is full with unusual and even unique economic relationship. One of the least understood involves the pec

admin2010-06-30  58
问题    The health-care economy is full with unusual and even unique economic relationship. 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. Where circumstances permit the buyer no choice 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 heath-care industry, the doctor-patient relationship is the mirror image of the original 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 decision: 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 ailment 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 ’ii’ is the doctor’s judgments that are final. Little wonder then that in the eyes 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 bona fide bills generated by the physician/hospital; and for the most part the patient plays a passive role. In routine or minor illness, or just plain worries, the patient’s options are, of course, much greater with respect to use and price.
   In illness that is of some significance, however, such choices tend to evaporate, and it is for ill ness that the bulk of the health-care dollar is spent. We estimate that about 75-80 percent of health care expenditures are determined by physicians, not patients. For this reason, economy measures directed at patients or the general public is relatively ineffective.
In significant illness, patients can
选项 A、choose what treatment they receive.
B、decide the price of their treatment.
C、pay only the about 75-80 percent of the expenditures.
D、have no options for treatment and price.
答案D
解析 文章倒数第二段最后一句和最后一段分别提到得小病的患者可以在治疗和价格方面有更多一些选择的余地，而患大病的患者则没有了这种选择余地。A的情况是得小病的患者所能做的。B与文意不符，得小病的患者能选择价格，但不能决定价格，这也不是患大病的患者能做的。C与文意不符，文章是说花费的75-80%由医生决定。
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