Thehealth-careeconomyisfilledwithunusualandevenuniqueeconomicrelationships．Oneoftheleastunderstoodinvolvesthepeculiarrolesofproduceror"provider"andpurchaseror"consumer"inthetypicaldoctor-patientrelati

Question

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 appealing factors of price，quality，and use，and it is the buyer who makes the decision．Such condition，however，is not common 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 rare that a patient 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 the decisions，but in general it is the doctor's judgments that are fi nal．Little wonder then that in the eye of the hospital it is the physician who is the real"consumer"．As a consequence，the med ical 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 choices are determined by physicians，not patients．For this reason，the economy directed at patients or the general is relatively ineffective．
 
28．The author's prim ary purpose in writing this passage is to___．
A．urge hospitals to reclaim their decision-making authority
B．inform potential patients of their health-care rights
C．criticize doctors for exercising too much control over patients
D．analyze some important economic factors in health-care
29．It can be inferred that doctors are able to determine hospital policies because___．
A．most of patient's bills are paid by his health insurance
B．it is doctors who generate income for the hospital
C．some patients might refuse to take their physician's advice
D．a doctor is ultimately responsible for a patient's health
30．According to the author，when a doctor tells a patient to"return next Wednesday"，the doctor is in fact___．
A．advising the patient to seek a second opinion
B．warning the patient that a hospital stay might be necessary
C．instructing the patient to buy more medical services
D．admitting that the first visit was ineffective
31．The author is most probably leading up to___．
A．a proposal to control medical costs
B．a study of lawsuits against doctors for malpractice
C．an analysis of the cause of inflation （通货膨胀） in the US
D．a discussion of a new medical treatment．

Answer 1

28-31 DBCA
28题答案是D．主旨大意题．文章首段表明本文将要讨论卫生保健行业中医生和病人的特殊经济关系，其余三段分析了这种经济关系的特别之处，由此可见，选项D可以概括本文主题．故选D．
29题答案是B．细节理解题．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有提到，前一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人．可知答案是B．
30题答案是C．推理判断题．根据在第2段第2句中，三个whether引出的例子是为了说明冒号前的"通常是由医生做出所有重要的购买决定"．可知选C．
31题答案是A．推理判断题．原文主要分析了医生和病人之间特殊的经济关系，末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，这样的体制显得ineffective．由此可以推断，作者接下来会提出对这种体制进行改革．故选A．