Question

9．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 toD．
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．a(chǎn)nalyze some important economic factors in health-care
29．It can be inferred that doctors are able to determine hospital policies becauseB．
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(chǎn) 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 factC．
A．a(chǎn)dvising 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．a(chǎn)dmitting that the first visit was ineffective
31．The author is most probably leading up toA．
A．a(chǎn) proposal to control medical costs
B．a(chǎn) study of lawsuits against doctors for malpractice
C．a(chǎn)n analysis of the cause of inflation （通貨膨脹） in the US
D．a(chǎn) discussion of a new medical treatment．

Answer 1

分析 本文講述了衛(wèi)生保健行業(yè)中的醫(yī)患關(guān)系中通常是由醫(yī)生做出所有重要的購買決定：病人是否應(yīng)該"下個星期三"來復(fù)診，是否需要拍X光片，是否需要開些藥，等等．很少有精明的病人會質(zhì)疑這些專業(yè)人員的決定，或者提前詢問價錢．在醫(yī)院看來，醫(yī)生才是真正的"消費者"．代表醫(yī)院"權(quán)力中心"來制定政策及決策的是醫(yī)護人員，而不是行政人員．但是醫(yī)生替各方做最重要的決定．醫(yī)院成了醫(yī)生的延伸．衛(wèi)生保健費用的75-80%是由醫(yī)生而不是病人決定的．因此，這種針對病人或普通老百姓的經(jīng)濟體制相對而言是無效的．

解答 28-31 DBCA
28題答案是D．主旨大意題．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(guān)系，其余三段分析了這種經(jīng)濟關(guān)系的特別之處，由此可見，選項D可以概括本文主題．故選D．
29題答案是B．細節(jié)理解題．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．可知答案是B．
30題答案是C．推理判斷題．根據(jù)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"．可知選C．
31題答案是A．推理判斷題．原文主要分析了醫(yī)生和病人之間特殊的經(jīng)濟關(guān)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．故選A．

點評 本文是健康環(huán)保類閱讀理解．做這類題材閱讀理解時要求考生對文章通讀一遍，做題時結(jié)合原文和題目有針對性的找出相關(guān)語句進行仔細分析，結(jié)合選項選出正確答案．推理判斷題也是要在抓住關(guān)鍵句子的基礎(chǔ)上合理的分析才能得出正確答案，切忌胡亂猜測，一定要做到有理有據(jù)．