题目内容
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 carder or government ) -- the physician makes the essential decision 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 to 80 percent of healthcare expenditures are determined by physicians, not patients. For this reason, economy directed at patients or the general are relatively ineffective. According to the author, when a doctor tells a patient to "return next Wednesday", the doctor is in effect ______.
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Humanity’s primal (原始的) efforts to systematize the concepts of size, shapes, and number are usually regarded as the earliest mathematics. However, the concept of number and the counting process developed so long (67) the time of recorded history (there is archaeological (68) that counting was employed by humans as far back as 50,000 years ago) that the (69) of this development is largely conjectural (好推测的). Imaging how it probably came (70) is not difficult. The argument that humans, (71) in prehistoric times, had some number sense, at least (72) the extent of recognizing the concepts of more and less when some objects were (73) to or taken away from a small group, seems fair, for studies have shown that some animal possesses such a (74) . With the (75) evolution of society, simple counting became necessary. A tribe had to know how many members it had and how many enemies, and shepherd needed to know (76) the flock of sheep was decreasing in size. Probably the earliest way of keeping a count was by some simple tally (计算, 记录) method, (77) the principle of one-to-one corre-spondence. In (78) a count of sheep, for example, one finger per sheep could be (79) . Counts could also be (80) by making scratches in the dirt or on a stone, by cutting notches in a piece of wood, or by tying knots in a string. (81) , perhaps later, an assortment of vocal (82) was developed as a word tally against the number of objects in, a small group. And (83) later, with the development of writing, a set of (84) was invented to stand for these numbers. Such an imagined development is (85) by reports of anthropologists in their studies of present-day societies that are (86) to be similar to those of early humans.
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 carder or government ) -- the physician makes the essential decision 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 to 80 percent of healthcare expenditures are determined by physicians, not patients. For this reason, economy directed at patients or the general are relatively ineffective. The author is most probably leading up to ______.
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 carder or government ) -- the physician makes the essential decision 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 to 80 percent of healthcare expenditures are determined by physicians, not patients. For this reason, economy directed at patients or the general are relatively ineffective. It can be inferred from the passage that doctors are able to determine hospital policies because ______.
Humanity’s primal (原始的) efforts to systematize the concepts of size, shapes, and number are usually regarded as the earliest mathematics. However, the concept of number and the counting process developed so long (67) the time of recorded history (there is archaeological (68) that counting was employed by humans as far back as 50,000 years ago) that the (69) of this development is largely conjectural (好推测的). Imaging how it probably came (70) is not difficult. The argument that humans, (71) in prehistoric times, had some number sense, at least (72) the extent of recognizing the concepts of more and less when some objects were (73) to or taken away from a small group, seems fair, for studies have shown that some animal possesses such a (74) . With the (75) evolution of society, simple counting became necessary. A tribe had to know how many members it had and how many enemies, and shepherd needed to know (76) the flock of sheep was decreasing in size. Probably the earliest way of keeping a count was by some simple tally (计算, 记录) method, (77) the principle of one-to-one corre-spondence. In (78) a count of sheep, for example, one finger per sheep could be (79) . Counts could also be (80) by making scratches in the dirt or on a stone, by cutting notches in a piece of wood, or by tying knots in a string. (81) , perhaps later, an assortment of vocal (82) was developed as a word tally against the number of objects in, a small group. And (83) later, with the development of writing, a set of (84) was invented to stand for these numbers. Such an imagined development is (85) by reports of anthropologists in their studies of present-day societies that are (86) to be similar to those of early humans.
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