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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.
Doctors are able to determine hospital policies most probably because ________.
选项 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
答案A
解析 根据题干关键词doctors，hospital policy定位到第3段。第3段末句开头的As a consequence表明医护人员能够决定医院政策的原因在前一句提到，该句指出医生才是真正的“消费者”，即医生才是给医院带来收入的来源，由此可见，选A。本题的答案应与本文的主题相关，讨论的是经济方面的问题，因为医生给医院带来收入，所以他们决定医院政策，这与医生的医德、专业知识等无关，因此，虽然其他三个选项在脱离题干的情况下都可能是符合实情的，但它们并不与题干直接构成因果关系。
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