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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. | 
