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　　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 t/he 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 t.he general is relatively ineffective.

　　1.What's the author's main purpose in writing this passage?

　　A) To criticize doctors for exercising too much control over patients.

　　B) To analyze some important economic factors in health-care.

　　C) To urge hospitals to reclaim their decision making authority.

　　D) To inform potential patients of their health-care rights.

　　2.In the health-care industry, the patients

　　A) perform the role of being "providers”

　　B) decide which physician to consult

　　C) never raise questions about price

　　D) never consult with the doctors

　　3.According to the author, when a doctor tells a patient to "return next Wednesday", the doctor is in effect___________,

　　A) instructing the patient to buy more medical services

　　B) warning the patient that a hospital stay might be necessary

　　C) advising the patient to seek a second opinion

　　D) admitting that the initial visit, was ineffective

　　4.Doctors are able to determine hospital policies most probably because_______.

　　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

　　5.The author is most probably leading up to_________.

　　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：

　　1.作者寫這篇文章的主要目的是什么?

　　A)譴責醫(yī)生對病人的控制太多。

　　B)分析衛(wèi)生保健中的幾個重要經(jīng)濟因素。

　　C)催促醫(yī)院收回他們的決策權。

　　D)讓潛在病人知道他們的衛(wèi)生保健權利。

　　[B]文章首段表明本文將要討論衛(wèi)生保健行業(yè)中醫(yī)生和病人的特殊經(jīng)濟關系，其余三段分析了這種經(jīng)濟關系的特別之處，由此可見，選項B可以概括本文主題，故為本題答案。

　　2.在衛(wèi)生保健行業(yè)，病人__________。

　　A)擔當“供應者”的角色

　　B)決定向哪一位醫(yī)生咨詢

　　C)從不問關于價錢的問題

　　D)從不向醫(yī)生咨詢

　　[A]第2段首句中的mirror image表明醫(yī)患關系與傳統(tǒng)的生產(chǎn)者一消費者的關系相反，即醫(yī)生充當消費者的角色，而患者充當生產(chǎn)者的角色，結合首段第2句中指出的生產(chǎn)者即供應者，可以推斷選項A為本題答案。

　　3.根據(jù)作者所述，當一位醫(yī)生告訴病人“下周三再來”時，醫(yī)生實際上是_________。

　　A)指示病人購買更多醫(yī)療服務

　　B)告誡病人需要住院治療

　　C)建議病人尋求另一種觀點

　　D)承認(病人)第一次到訪無效

　　[A]在第2段第2句中，三個whether引出的例子是為了說明冒號前的“通常是由醫(yī)生做出所有重要的購買決定”。選項中只有A與“購買”有關，故為本題答案。

　　4.醫(yī)生能夠決定醫(yī)院方案，最可能是因為___________。

　　A)醫(yī)院的財政收入靠醫(yī)生

　　B)病人的健康最終由醫(yī)生決定

　　C)大多數(shù)病人不會挑戰(zhàn)醫(yī)生的決定

　　D)行政部門對醫(yī)藥的了解比醫(yī)生少

　　[A]第3段末句開頭的As a consequence表明醫(yī)護人員能夠決定醫(yī)院政策的原因在前一句有提到，前一句指出醫(yī)生才是真正的“消費者”，即醫(yī)生才是給醫(yī)院帶來收入的人，由此可見，選項A為本題答案。

　　5.作者在下文最可能是會_______________。

　　A)分析醫(yī)院行政擔當?shù)慕巧?/P>

　　B)研究關于醫(yī)生失職的訴訟

　　C)討論一種新的醫(yī)療

　　D)提議對醫(yī)療費用進行管控

　　[D]原文主要分析了醫(yī)生和病人之間特殊的經(jīng)濟關系，末段最后兩句指出大部分衛(wèi)生保健費用由醫(yī)生決定，正因為如此，這樣的體制顯得ineffective。由此可以推斷，作者接下來會提出對這種體制進行改革，選項D與此最為接近。

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