淘金高阶英语六级巅峰阅读 篇章阅读35：医疗消费

　　篇章阅读35：医疗消费

　　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 doctors 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 -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.

　　参考译文

　　卫生保健行业存在着许多不同寻常的、甚至是独一无二的经济关系。其中人们了解最少的包括在典型的医患关系中生产者或 供应者 与购买者或 消费者 之闻的奇特的角色关系。在大部分经济领域，是销售者努力用价格、质量、用途等各种诱惑来吸引潜在的购买者，而做决定的是购买者。然而，在卫生保健行业，多数情况下并不是这样的。

　　卫生保健行业中的医患关系与一般的生产者-消费者之间的关系刚好相反。一旦某人选择了请某个医生看病一一即使在那时可能并没有真正的选择余地一一通常是由医生做出所有重要的购买决定：病人是否应该 下个星期三 来复诊，是否需要拍X光片，是否需要开些药，等等。很少有精明的病人会质疑这些专业人员的决定，或者提前询问价钱，尤其是当其病情非常严重的时候。

　　当需要住院治疗时，这种关系尤为明显。医生必须证明住院的必要性，决定需要哪些治疗过程，宣布病人何时可以出院。其中某些决定可能会征求病人的意见，但一般情况下，医生的决定才具有决定性。难怪在医院看来，医生才是真正的 消费者 。这样做的结果是，代表医院 权力中心 来制定政策及决策的是医护人员，而不是行政人员。

　　虽然在这种情况下通常有四方可识别的参与者一一医生、医院、病人及付款者(一般为保险公司或政府)一一但是医生替各方做最重要的决定。医院成了医生的延伸：付款者通常支付医生/医院开出的大部分费用，而在很大程度上病人都是一个被动的角色。据估计，卫生保健费用的75-80%是由医生而不是病人决定的。因此，这种针对病人或普通老百姓的经济体制相对而言是无效的。

　　测试题

　　1.Whats the authors 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 patients health

　　C) most of the patients dont challenge the doctors decisions

　　D) the administration doesnt 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

　　答案详解

　　1.作者写这篇文章的主要目的是什么?

　　A)谴责医生对病人的控制太多。

　　B)分析卫生保健中的几个重要经济因素。

　　C)催促医院收回他们的决策权。

　　D)让潜在病人知道他们的卫生保健权利。

　　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B可以概括本文主题，故为本题答案。

　　2.在卫生保健行业，病人__________。

　　A)担当 供应者 的角色

　　B)决定向哪一位医生咨询

　　C)从不问关于价钱的问题

　　D)从不向医生咨询

　　第2段首句中的mirror image表明医患关系与传统的生产者一消费者的关系相反，即医生充当消费者的角色，而患者充当生产者的角色，结合首段第2句中指出的生产者即供应者，可以推断选项A为本题答案。

　　3.根据作者所述，当一位医生告诉病人 下周三再来 时，医生实际上是_________。

　　A)指示病人购买更多医疗服务 B)告诫病人需要住院治疗

　　C)建议病人寻求另一种观点 D)承认(病人)第一次到访无效

　　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 。选项中只有A与 购买 有关，故为本题答案。

　　4.医生能够决定医院方案，最可能是因为___________。

　　A)医院的财政收入靠医生 B)病人的健康最终由医生决定

　　C)大多数病人不会挑战医生的决定 D)行政部门对医药的了解比医生少

　　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，由此可见，选项A为本题答案。

　　5.作者在下文最可能是会_______________。

　　A)分析医院行政担当的角色 B)研究关于医生失职的诉讼

　　C)讨论一种新的医疗 D)提议对医疗费用进行管控

　　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，选项D与此最为接近。